title: Impact of acute kidney injury on long-term mortality and progression to chronic kidney disease among critically ill children.
abstract: To determine the 2-year outcome of acute kidney injury (AKI) following admission to pediatric critical care units (PICU). Methods: A retrospective cohort study was conducted between January 2012 and December 2013. We followed 131 children admitted to PICU, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia with a diagnosis of AKI, based on pRIFLE (pediatric risk, injury, failure, loss, and end-stage renal disease), for 2 years. During the study period, 46 children died and 38 of survivors completed the follow-up. Factors affecting long-term progression to chronic kidney disease were also evaluated. Results: The 2-year mortality was more than 40%. The main determinant of the 2-year mortality was the pediatric risk of mortality (PRISM) score, which increased the risk of mortality by 6% per each one score (adjusted odds ratio, 1.06: 95% confidence interval: 1.00-1.11). By the end of the 2 years, 33% of survivors had reduction in the glomerular filtration rate and proteinuria, and 73% were hypertensive. Patients with more severe renal impairment at admission, based on the pRIFLE criteria, had higher mortality rate. This association, however, was not independent since it was influenced by baseline disease severity (PRISM score).  Conclusion: Large proportion of patients admitted to PICU with AKI either died during the first 2 months of follow-up or developed long-term complications. The severity of AKI, however, was not an independent risk factor for mortality.
authors.affiliation: Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail. dr.n.gh@hotmail.com.
authors.forename: Najlaa G
authors.initials: NG
authors.lastname: Al-Otaibi
authors.forename: Maryam
authors.initials: M
authors.lastname: Zeinelabdin
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Shalaby
authors.forename: Norah
authors.initials: N
authors.lastname: Khathlan
authors.forename: Ghadi D
authors.initials: GD
authors.lastname: Mashat
authors.forename: Amal A
authors.initials: AA
authors.lastname: Zahrani
authors.forename: Sundus Mw
authors.initials: SM
authors.lastname: NoorSaeed
authors.forename: Nora M
authors.initials: NM
authors.lastname: Shalabi
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Alhasan
authors.forename: Sara N
authors.initials: SN
authors.lastname: Sharief
authors.forename: Amr S
authors.initials: AS
authors.lastname: Albanna
authors.forename: Jameela A
authors.initials: JA
authors.lastname: Kari
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000473:pathology; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors