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Outcome of Pediatric Acute Kidney Injury
Objectives
This chapter will:
- 1.
Compare mortality rates observed in various critically ill pediatric populations in which acute kidney injury develops.
- 2.
Analyze outcomes for children who acquire acute kidney injury in terms of need for renal replacement therapy.
- 3.
Identify clinical variables associated with increased mortality in critically ill children with acute kidney injury who receive renal replacement therapy.
- 4.
Review long-term sequelae in children who survive an episode of acute kidney injury.
The study of pediatric acute kidney injury (AKI) outcomes has undergone an increased focus in the past two decades, with significant attention paid to children who receive renal replacement therapy (RRT). Most data come from retrospective single-center studies, however, so very little evidence is available regarding therapeutic measures that may prevent or ameliorate pediatric AKI. Three different pediatric AKI outcome measures are addressed in this chapter: (1) mortality, (2) the need for RRT, and (3) long-term sequelae in patients who survive an AKI episode.
Hospitalized Children
As noted in Chapter 199 , the epidemiology of pediatric AKI has changed from predominantly primary kidney diseases to AKI caused by other underlying systemic illness or their treatment. Studies through the past decade demonstrate that overall survival rates of hospitalized children with AKI are remarkably similar across different countries and studies. Hui-Stickle et al. noted a 70% survival rate in their study in the United States of 246 patients but also found lower survival among infants (younger than 1 year of age) than among older children (60% vs. 77%; p < .0001). In two separate studies, Vachvanichsanong and Williams reported survival rates of 64% (n = 311 children) and 72% (n = 228 children), respectively, with each study encompassing 20 years of hospitalizations. Large pediatric AKI studies before 1990 show similar survival rates of 58% to 75%. Although the stable pediatric AKI survival rates noted earlier could be interpreted to reflect lack of improvement in the care of children with AKI, it is more likely to reflect the provision of care for a greater number of critically ill children who acquire AKI than was the case in earlier decades.
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