Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Pediatr Nephrol. 2023 Feb;38(2):565-572. doi: 10.1007/s00467-022-05579-1. Epub 2022 May 13.
Continuous kidney replacement therapy (CKRT) is a mainstay of therapy for management of severe acute kidney injury (AKI) in critically ill pediatric patients. There is limited data on the risk of chronic kidney disease (CKD) after discharge in this population.
This is a single-center, retrospective cohort study of all pediatric patients ages 0-17 years who received CKRT from 2013 to 2017. The study excluded patients with pre-existing CKD, those who died prior to discharge, and those who had insufficient follow-up data. Patients were followed after hospital discharge and electronic health record data was collected and analyzed to assess for incidence of and risk factors for kidney sequelae.
A total of 42 patients were followed at a median time of 27 months (IQR 17.2, 39.8). Of these, 26.2% had evidence of CKD and 19% were at risk for CKD. Lower eGFR at hospital discharge was associated with increased odds of kidney sequelae (aOR 0.985; 95% CI 0.972, 0.996). Ages 0- < 1 and 12-17 were not significantly different (aOR 0.235, 95% CI 0.024, 1.718) and had the highest incidence of kidney sequelae (50% and 77%, respectively). Ages 1-5 and 6-11 had a decreased odds of kidney sequelae compared to the 12-17 year age group (aOR 0.098; 95% CI 0.009, 0.703 and aOR 0.035; 95% CI 0.001, 0.39, respectively). Only 54.8% of patients (n = 23) were seen in the nephrology clinic after discharge.
Patients who receive CKRT for AKI have a significant risk of CKD, while follow-up with a pediatric nephrologist in these high-risk patients is sub-optimal. A higher resolution version of the Graphical abstract is available as Supplementary information.
连续肾脏替代疗法（CKRT）是治疗危重症儿科患者严重急性肾损伤（AKI）的主要方法。关于该人群出院后慢性肾脏病（CKD）风险的数据有限。
这是一项对 2013 年至 2017 年期间接受 CKRT 的所有 0-17 岁儿科患者的单中心回顾性队列研究。该研究排除了患有预先存在的 CKD、出院前死亡或随访数据不足的患者。在出院后对患者进行随访，并收集电子健康记录数据以评估肾脏后遗症的发生率和危险因素。
共有 42 例患者在中位时间 27 个月（IQR 17.2，39.8）后得到随访。其中，26.2%的患者有 CKD 证据，19%的患者有 CKD 风险。出院时的 eGFR 较低与肾脏后遗症的发生几率增加相关（优势比 0.985；95%置信区间 0.972，0.996）。0-<1 岁和 12-17 岁年龄组之间无显著差异（优势比 0.235，95%置信区间 0.024，1.718），且肾脏后遗症发生率最高（分别为 50%和 77%）。与 12-17 岁年龄组相比，1-5 岁和 6-11 岁年龄组肾脏后遗症的发生几率降低（优势比 0.098；95%置信区间 0.009，0.703 和优势比 0.035；95%置信区间 0.001，0.39）。只有 54.8%（n=23）的患者在出院后到肾病科就诊。
接受 AKI 治疗的 CKRT 患者发生 CKD 的风险显著，而在这些高危患者中接受儿科肾病医生的随访情况并不理想。更清晰的图表版本可以在补充材料中查看。
