Acute Kidney Injury (AKI) Associated with Chronic Kidney Disease (CKD) in Paediatric Non-Kidney Transplant Recipients.
1University of Toronto, Toronto, Canada
2Hospital for Sick Children, Toronto, Canada
3University Health Network, Toronto, Canada
4University of Wisconsin, Madison.
Meeting: 2016 American Transplant Congress
Abstract number: 232
Keywords: Glomerular filtration rate (GFR), Pediatric, Renal failure, Renal injury
Session Information
Date: Monday, June 13, 2016
Session Name: Concurrent Session: Kidney: Pediatrics
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 311
Background: Kidney dysfunction is common after solid organ transplantation; however, rates of post-transplant AKI and CKD in children are unknown.
Objective: Determine rates of AKI and CKD among childhood recipients of non-kidney solid organ transplants (heart, lung, liver or multiple organs).
Methods: Cohort study of all children (<18 years) with a non-kidney transplant at Hospital for Sick Children, Toronto (2002-2011). AKI in the first year defined per international guidelines and CKD defined by creatinine-based estimated glomerular filtration rate (eGFR) <60 mL/min/m2 for 6 months. End stage renal disease (ESRD) defined as initiation of dialysis or receipt of a kidney transplant. Those who received pre-transplant dialysis or were followed <90 days were excluded. Risk of CKD as a function of AKI and other covariates was evaluated in a Cox model.
Results: A total of 304 children were transplanted at median age of 4.0 years (IQR: 0.7-11.9); 55% were male. A total of 88 developed AKI and 24 CKD. Incidence by organ and overall is shown in Table 1. Three children developed ESRD, all within 65 days post-transplant. By Cox regression, those with 1 AKI event versus no AKI event had significantly greater risk (HR 2.7, 95%CI 1.1-6.3) for CKD after controlling for age, sex, baseline eGFR and calcineurin inhibitor use.
Conclusions: AKI and CKD are common in children with non-kidney solid organ transplants. Close monitoring to prevent AKI events may impact long-term risk for kidney disease progression.
| Table 1: Acute kidney injury (AKI) and chronic kidney disease (CKD) rates for 304 children transplanted at SickKids | |||||
| Heart (n=125) | Lung (n=22) | Liver (n=145) | Multiple (n=12) | Total (n=304) | |
| AKI | |||||
| Number with 1 or more AKI events | 30 | 10 | 43 | 5 | 88 |
| Incidence rate for first AKI event (95%CI)* |
303(212-434) |
707(380-1313) |
400(297-540) |
704(293-1691) |
387(314-476) |
| Median time to first event, days | 53 | 70 | 84 | 35 | 70 |
| Mean number of all AKI events | 1.2+0.5 | 1.3+0.5 | 1.3+0.6 | 1.6+0.9 | 1.3+0.6 |
| CKD | |||||
| Number with CKD | 11 | 7 | 5 | 1 | 24 |
| Incidence rate (95%CI)* |
23(13-42) |
158(75-331) |
9(4-22) |
25(4-177) |
21(14-32) |
| Median time to event, days | 177 | 235 | 441 | 136 | 193 |
|
*per 1000 person-years |
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CITATION INFORMATION: Williams C, Borges K, Banh T, Vasilevska-Ristovska J, Chanchlani R, Ng V, Dipchand A, Solomon M, Hebert D, Kim S, Astor B, Parekh R. Acute Kidney Injury (AKI) Associated with Chronic Kidney Disease (CKD) in Paediatric Non-Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Williams C, Borges K, Banh T, Vasilevska-Ristovska J, Chanchlani R, Ng V, Dipchand A, Solomon M, Hebert D, Kim S, Astor B, Parekh R. Acute Kidney Injury (AKI) Associated with Chronic Kidney Disease (CKD) in Paediatric Non-Kidney Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/acute-kidney-injury-aki-associated-with-chronic-kidney-disease-ckd-in-paediatric-non-kidney-transplant-recipients/. Accessed July 21, 2018.« Back to 2016 American Transplant Congress