is justifies improved surveillance after pediatric AKI to detect CKD and hypertension early and improve long-term kidney health. Background AKI is common in hospitalized children. Pediatric AKI receiving acute KRT is associated with long-term CKD, hypertension, and death. We aim to determine the outcomes after AKI in children who did not receive acute KRT because these remain uncertain. Methods Retrospective cohort study of all hospitalized children (0–18 years) surviving AKI without acute KRT between 1996 and 2020 in Ontario, Canada, identified by validated diagnostic codes in provincial administrative health databases. Children with prior KRT, CKD, or AKI were excluded. Cases were matched with up to four hospitalized comparators without AKI by age, neonatal status, sex, intensive care unit admission, cardiac surgery, malignancy, hypertension, hospitalization era, and a propensity score for AKI. Patients were followed until death, provincial emigration, or censoring in March 2021. The primary outcome was long-term major adverse kidney events (a composite of all-cause mortality, long-term KRT, or incident CKD). Results We matched 4173 pediatric AKI survivors with 16,337 hospitalized comparators. Baseline covariates were well-balanced following propensity score matching. During a median 9.7-year follow-up, 18% of AKI survivors developed long-term major adverse kidney event versus 5% of hospitalized comparators (hazard ratio [HR], 4.0; 95% confidence interval [CI], 3.6 to 4.4). AKI survivors had higher rates of long-term KRT (2% versus <1%; HR, 11.7; 95% CI, 7.5 to 18.4), incident CKD (16% versus 2%; HR, 7.9; 95% CI, 6.9 to 9.1), incident hypertension (17% versus 8%; HR, 2.3; 95% CI, 2.1 to 2.6), and AKI during subsequent hospitalization (6% versus 2%; HR, 3.7; 95% CI, 3.1 to 4.5), but no difference in all-cause mortality (3% versus 3%; HR, 0.9; 95% CI, 0.7 to 1.1). Conclusions Children surviving AKI without acute KRT were at higher long-term risk of CKD, long-term KRT, hypertension, and subsequent AKI versus hospitalized comparators....

中文翻译：

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小儿急性肾损伤后的长期肾脏结局


证明改进儿科 AKI 后监测以早期发现 CKD 和高血压并改善长期肾脏健康是合理的。背景 AKI 在住院儿童中很常见。接受急性 KRT 的儿科 AKI 与长期 CKD、高血压和死亡相关。我们的目标是确定未接受急性 KRT 的儿童 AKI 后的结局，因为这些结局仍不确定。方法 对 1996 年至 2020 年加拿大安大略省所有无急性 KRT 的 AKI 幸存者 （0-18 岁） 的住院队列研究，通过省级行政卫生数据库中经过验证的诊断代码确定。既往患有 KRT 、 CKD 或 AKI 的儿童被排除在外。根据年龄、新生儿状况、性别、重症监护病房收治、心脏手术、恶性肿瘤、高血压、住院年龄和 AKI 倾向评分，将病例与最多 4 名无 AKI 的住院对照者进行匹配。对患者进行随访，直到 2021 年 3 月死亡、省级移民或审查。主要结局是长期主要不良肾脏事件 （全因死亡率、长期 KRT 或新发 CKD 的复合）。结果 我们将 4173 例儿科 AKI 幸存者与 16,337 例住院对照者进行了匹配。倾向评分匹配后，基线协变量平衡良好。在中位 9.7 年的随访中，18% 的 AKI 幸存者发生长期严重不良肾脏事件，而住院对照组为 5% （风险比 [HR]，4.0;95% 置信区间 [CI]，3.6 至 4.4）。AKI 幸存者的长期 KRT 发生率较高 （2% vs <1%;心率，11.7;95% CI，7.5 至 18.4）、事件 CKD （16% 对 2%;人力资源，7.9;95% CI，6.9 至 9.1），新发高血压 （17% 对 8%;心率，2.3;95% CI，2.1 至 2.6）和随后住院期间的 AKI （6% 对 2%;人力资源，3.7;95% CI，3.1 至 4.5），但全因死亡率无差异（3% vs 3%;心率，0.9;95% CI，0.7 至 1.1）。结论 与住院对照组相比，无急性 KRT 的 AKI 存活儿童发生 CKD、长期 KRT、高血压和随后的 AKI 的长期风险更高。