Karmakar Shreyashi, Dasgupta Deblina, Akhtar Shakil, Poddar Sanjukta, Giri Prabhas Prasun, Tse Yincent, Sinha Rajiv
Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India.
Division of Pediatric Intensive Care, Institute of Child Health, Kolkata, India.
Pediatr Nephrol. 2025 May 21. doi: 10.1007/s00467-025-06810-5.
Prospective studies on kidney outcomes in critically ill children with acute kidney injury (AKI) are scarce from low- and middle-income countries (LMIC). We conducted a pilot study to evaluate the continuum of transient AKI-persistent AKI-acute kidney disease (AKD) and chronic kidney disease (CKD).
Children (1-18 years) admitted to our tertiary Pediatric Intensive Care Unit (PICU) and developing AKI with no known pre-existing kidney co-morbidities from January 2021 to June 2022 were included with follow up visits at 1 and 3 months after AKI onset. AKI and CKD were defined as per KDIGO 2012. At risk of CKD was defined by albuminuria, hypertension, estimated glomerular filtration rate (eGFR) 60-90 ml/kg/1.73 m or hyperfiltration (eGFR ≥ 150 ml/kg/1.73 m).
Of 390 children, 15% (n = 57) developed AKI. 75% (n = 43) with AKI had underlying primarily non-kidney systemic etiology. Fourteen (25%) died at median 5 days (IQR 4-7) after admission, and three were lost to follow up after discharge. For the 40 AKI survivors with three months data, incidence of transient AKI was 40% (n = 16), persistent AKI 20% (n = 8), AKD 32% (n = 13), and CKD 8% (n = 3). In addition, 18% (n = 7) were at risk of CKD. 38% with AKI for > 48 h vs. 6% with AKI < 48 h developed CKD or were at risk of CKD (p = 0.025). All three AKI survivors who progressed to CKD had an underlying primarily kidney etiology and progressed from AKD to CKD.
In this LMIC study, kidney sequelae were high at 3 months among PICU AKI survivors. This pilot supports the need and feasibility of larger prospective trials in LMIC settings to understand outcomes for all children with AKI.
来自低收入和中等收入国家（LMIC）的关于危重症急性肾损伤（AKI）儿童肾脏预后的前瞻性研究很少。我们开展了一项试点研究，以评估短暂性AKI-持续性AKI-急性肾病（AKD）和慢性肾病（CKD）的连续情况。
纳入2021年1月至2022年6月入住我们三级儿科重症监护病房（PICU）且发生AKI且无已知既往肾脏合并症的1-18岁儿童，并在AKI发病后1个月和3个月进行随访。AKI和CKD根据KDIGO 2012进行定义。CKD风险定义为蛋白尿、高血压、估计肾小球滤过率（eGFR）60-90 ml/kg/1.73 m²或超滤（eGFR≥150 ml/kg/1.73 m²）。
390名儿童中，15%（n = 57）发生AKI。发生AKI的儿童中75%（n = 43）主要有非肾脏系统性病因。14名（25%）在入院后中位5天（IQR 4-7）死亡，3名在出院后失访。对于有三个月数据的40名AKI幸存者，短暂性AKI的发生率为40%（n = 16），持续性AKI为20%（n = 8），AKD为32%（n = 13），CKD为8%（n = 3）。此外，18%（n = 7）有CKD风险。AKI持续>48小时的儿童中38%发生CKD或有CKD风险，而AKI持续<48小时的儿童中这一比例为6%（p = 0.025）。所有进展为CKD的三名AKI幸存者均主要有肾脏病因，且从AKD进展为CKD。
在这项LMIC研究中，PICU中AKI幸存者在3个月时肾脏后遗症发生率很高。这项试点研究支持在LMIC环境中开展更大规模前瞻性试验以了解所有AKI儿童预后的必要性和可行性。
