The pattern and prognostic factors for kidney function progression in children with acute kidney injury and acute kidney disease

Abstract Background: There is a paucity of data describing the progression of kidney function from acute kidney injury (AKI) to acute kidney disease (AKD) among children. Methods: A prospective cohort study on pediatric AKI was conducted from 6/2020 to 6/2021 on critically ill children aged 1 month to ≤18 years old. The 90-day natural history of kidney function progression was described. Prognostic factors associated with development of AKD and various outcomes were identified. Results: Among the 253 episodes of admission, 58.1% were male with a median (interquartile range) age of 4.9 (9.7) years The AKI incidence was 41.9% and 73.6% of children with AKI developed AKD. Parameters signifying more severe and prolonged AKI and higher degree of nephrotoxic medication exposure were significant determinants of AKI progression and AKD development. At 90 days, 31.5% of children had serum creatinine level (SCr) ≥1.5 times of baseline, 10.4% had an estimated glomerular filtration rate (eGFR) <90ml/min/1.73m2 and the mortality was 6.7%. Children with AKI followed by AKD had the highest risk of having SCr ≥1.5 times of baseline (HR 13.59 [6.07, 30.46]) and eGFR <90ml/min/1.73m2 (HR 12.56 [3.19, 49.38]). Persistent AKI was significantly associated with 90-day mortality (HR 7.06 [2.72, 18.3]). Conclusions: Pediatric AKI survivors were at risk of developing AKD. The severity and duration of AKI and AKD were important determinants of outcomes. Children with both AKI and AKD carried the highest risk of kidney function non-recovery at 90 days. A follow-up visit is warranted for children who survived AKI.