Ulrich Emma H, Hessey Erin, Perreault Sylvie, Dorais Marc, Jouvet Philippe, Phan Veronique, Zappitelli Michael
Division of Pediatric Nephrology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
Crit Care Explor. 2022 Jan 18;4(1):e0614. doi: 10.1097/CCE.0000000000000614. eCollection 2022 Jan.
Acute kidney injury is common in critically ill children, but the long-term outcomes are not well defined.
Evaluated whether nonrecovery of kidney function, following acute kidney injury, was associated with postdischarge mortality, healthcare utilization, and chronic kidney disease.
Retrospective, two-center, observational study.
Two ICUs at tertiary children's hospitals in Montreal, QC.
Pediatric patients (age ≤ 18 yr) with index admission to intensive care between January 1, 2003, and March 31, 2005. Children were excluded if they 1) died during admission, 2) did not have serum creatinine or urine output measured, 3) did not develop acute kidney injury, 4) could not be linked to administrative health data, and 5) (for chronic kidney disease outcome) had pre-existing renal disease by chart review, baseline estimated glomerular filtration rate measurement, or administrative health data codes.
Three-hundred seventy-eight patients' data were included for long-term mortality and healthcare utilization outcomes; 316 patients for long-term chronic kidney disease outcome. Outcomes were defined using provincial administrative healthcare data diagnosis, procedure, and billing codes.
Nonrecovery of kidney function, defined as serum creatinine greater than or equal to 1.5× baseline at ICU discharge, occurred in 51 patients (13%). Nonrecovery of kidney function was not associated with long-term mortality (at 5-7 yr following hospital discharge), increased hospitalizations or emergency department visits (at 30-days, 1-year, and 5-yr follow-up), or increased physician visits (at 1- and 5-yr follow-up). Nonrecovery was associated with increased 30-day physician visits (adjusted relative risk, 1.40; 95% CI, 1.13-1.73) and chronic kidney disease diagnosis within 5 years of discharge (adjusted hazard ratio, 4.92, 95% CI, 1.77-13.70).
Nonrecovery of kidney function following an episode of acute kidney injury in critically ill children is associated with nearly five-fold increased risk for long-term chronic kidney disease. Acute kidney injury nonrecovery may be a useful marker to identify patients that are particularly important to follow-up post discharge for chronic kidney disease detection.
急性肾损伤在危重症儿童中很常见，但长期预后尚不明确。
评估急性肾损伤后肾功能未恢复是否与出院后死亡率、医疗资源利用及慢性肾脏病有关。
回顾性、双中心观察性研究。
魁北克省蒙特利尔市两家三级儿童医院的重症监护病房。
2003年1月1日至2005年3月31日期间首次入住重症监护病房的儿科患者（年龄≤18岁）。若儿童存在以下情况则被排除：1）住院期间死亡；2）未测量血清肌酐或尿量；3）未发生急性肾损伤；4）无法与行政卫生数据关联；5）（针对慢性肾脏病结局）通过病历审查、基线估计肾小球滤过率测量或行政卫生数据编码存在既往肾脏疾病。
纳入378例患者的数据用于长期死亡率和医疗资源利用结局分析；316例患者用于长期慢性肾脏病结局分析。结局通过省级行政医疗保健数据诊断、程序和计费编码来定义。
51例患者（13%）出现肾功能未恢复，定义为重症监护病房出院时血清肌酐≥基线值的1.5倍。肾功能未恢复与长期死亡率（出院后5 - 7年）、住院次数增加或急诊就诊次数增加（30天、1年和5年随访时）或门诊就诊次数增加（1年和5年随访时）无关。肾功能未恢复与30天门诊就诊次数增加（调整后相对风险，1.40；95%置信区间，1.13 - 1.73）及出院后5年内慢性肾脏病诊断有关（调整后风险比，4.92，95%置信区间，1.77 - 13.70）。
危重症儿童急性肾损伤发作后肾功能未恢复与长期慢性肾脏病风险增加近五倍有关。急性肾损伤未恢复可能是一个有用的标志物，用于识别出院后对慢性肾脏病检测进行随访特别重要的患者。
