Mr Marc Chami1, Dr Sean Kennedy1,2
1School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia, 2Paediatric Nephrology, Sydney Children’s Hospital Randwick, Sydney, Australia
Aim: To describe the rates of recovery of kidney function in children with severe acute kidney injury (AKI) requiring kidney replacement therapy (KRT) and identify predisposing factors for incomplete recovery.
Background: AKI requiring KRT occurs in over 10% of children in paediatric intensive care units (PICU). Up to 1 in 3 of these children die from severe AKI and a proportion will be left with impaired kidney function, however long term follow up data are sparse.
Methods: We conducted a retrospective study of children admitted to a tertiary PICU who received KRT for AKI between January 2012 and September 2020. Outcomes were length of hospital stay, mortality, and recovery of kidney function. Covariates were age, aetiology, and the proportional elevation of serum creatinine (SCr) from baseline.
Results: 101 patients received KRT for AKI. The median length of hospital stay was 25 days (IQR, 13–52) and 28 patients (28%) died without recovery. Patients with AKI secondary to bone marrow transplant were the most likely to die (p<0.01, OR=9.30) while no patients died from primary renal diseases such as haemolytic uremic syndrome and thrombotic thrombocytopenic purpura. Sixteen out of 73 survivors (22%) did not recover to within 50% of their baseline SCr by discharge. Poor recovery of kidney function was associated with a greater peak elevation of SCr (p<0.001) and AKI due to primary renal disease (p<0.01, OR=0.12).
Conclusion: The rates of mortality and recovery in children with severe AKI were influenced by aetiology and elevation of SCr. All patients with severe AKI should be followed up and monitored for signs of renal impairment.
Biography:
Marc Chami is a medical student at the University of New South Wales and a student researcher under the supervision of Dr Sean Kennedy. He is particularly interested in paediatric research, and is now working with Dr Kennedy on eliciting risk factors for impaired recovery after acute kidney injury in children.