title: Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review.
abstract: BACKGROUND
  Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality in children. However, the risk for long-term outcomes after AKI is largely unknown.
  
  
  METHODS
  We performed a systematic review and meta-analysis to determine the cumulative incidence rate of proteinuria, hypertension, decline in glomerular filtration rate (GFR), and mortality after an episode of AKI. After screening 1934 published articles from 1985-2013, we included 10 cohort studies that reported long-term outcomes after AKI in children.
  
  
  RESULTS
  A total of 346 patients were included in these studies with a mean follow-up of 6.5 years (range 2-16) after AKI. The studies were of variable quality and had differing definitions of AKI with five studies only including patients who required dialysis during an AKI episode. There was a substantial discrepancy in the outcomes across these studies, most likely due to study size, disparate outcome definitions, and methodological differences. In addition, there was no non-AKI comparator group in any of the published studies. The cumulative incidence rates for proteinuria, hypertension, abnormal GFR (<90 ml/min/1.73 m2), GFR < 60 ml/min/1.73 m2, end stage renal disease, and mortality per 100 patient-years were 3.1 (95% CI 2.1-4.1), 1.4 (0.9-2.1), 6.3 (5.1-7.5), 0.8 (0.4 -1.4), 0.9 (0.6-1.4), and 3.7 (2.8-4.5) respectively.
  
  
  CONCLUSIONS
  AKI appears to be associated with a high risk of long-term renal outcomes in children. These findings may have implications for care after an episode of AKI in children. Future prospective studies with appropriate non-AKI comparator groups will be required to confirm these results.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Greenberg
authors.forename: Steven
authors.initials: S
authors.lastname: Coca
authors.affiliation: Department of Internal Medicine, Section of Nephrology, New Haven, CT and VA Medical Center, Yale University School of Medicine, West Haven, CT, USA. chirag.parikh@yale.edu.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000401:mortality*; D018570:Risk Assessment; D016896:Treatment Outcome