Long-Term Clinical Outcomes Following Pediatric AKI

Background: Previous studies on the long-term outcomes following pediatric AKI have yielded conflicting evidence. Methods: This retrospective cohort study data was drawn from the China Renal Data System (CRDS) between 2013 and 2023. Children (30 days-18 years) with surviving AKI were enrolled in this study. AKI was defined according to the KDIGO guidelines, and propensity score matching (PSM) was implemented (1:3 ratio) to establish non-AKI comparators. The primary outcome was major adverse kidney events (MAKE, (a composite of death, long-term kidney failure [KRT], or new-onset chronic kidney disease [CKD]), and secondary outcomes comprised individual component endpoints and cardiovascular mortality. Multivariate Cox hazard regression models and competing risks regression were performed to explore the relationship between AKI and outcomes, as well as to conduct subgroup analyses according to patient characteristics. Results: Among the 44,693 children (mean [SD] age, 6.1 [5.5] years; 27,521 boys [61.6%]) included in this study, 10,664 were survived AKI. The multivariate Cox model showed that AKI survivors demonstrated significantly higher risks of MAKE (adjusted hazard ratio [aHR]: 1.43 , 95% confidence interval [CI] 1.32-1.55), all-cause mortality (aHR: 1.42, 95%CI, 1.30-1.55), cardiovascular mortality (aHR: 1.42, 95%CI, 1.30-1.55), KRT (aHR: 3.00 , 95%CI, 2.24, 4.02), and CKD (aHR: 1.32, 95%CI, 1.21,1.44) compared to controls. The associations were consistent in various subgroups (Figure). Conclusion: Children surviving AKI were at higher long-term risk of MAKE, all-cause and CVD mortality, KRT and CKD versus hospitalized comparators.