Transient And Persistent Acute Kidney Injury In Children Hospitalized With Decompensated Heart Failure
HFSA ePoster Library. Kaushal S. 09/10/21; 343603; 48
Sonia Kaushal
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Abstract
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Background: Acute kidney injury (AKI) occurs commonly in children hospitalized with heart failure (HF) and is strongly associated with worse clinical outcomes including death and need for mechanical circulatory support. Recent data in adults suggest that not all AKI in HF is the same. Patients with transient AKI, as opposed to those with persistent AKI, may have better outcomes. Data in pediatric HF, however, is lacking.
Objectives: We sought to determine the prevalence, risk factors, and outcomes of transient and persistent AKI in children hospitalized with HF.
Methods: We performed a single center retrospective analysis of patients < 21 years old with acute decompensated HF admitted between 2011 to 2015. Patients with existing and new onset HF who required hospitalization for an exacerbation were included. Patients <3 months of age and those with a history of chronic kidney disease were excluded. AKI was defined as a decrease of > 25% in estimated glomerular filtration rate (eGFR) during hospitalization. A baseline eGFR of 100 was assumed, and those who presented with a eGFR of < 75 were deemed to have AKI at admission. AKI was classified as transient if it recovered within 48 hours of onset, all others were deemed persistent. Multiple episodes of AKI during hospitalization were reviewed for inclusion. The primary composite outcome was death within 60 days of hospitalization or the use of mechanical circulatory support (MCS) during hospitalization. Univariate analysis was conducted with chi square, fishers exact test, T-test, and Wilcoxon rank-sum test. Multivariable logistic regression was used to predict composite outcome.
Results: Of the 135 patients included in the analysis, 76 (56%) developed AKI with 52 (68.5%) meeting criteria for persistent AKI. Patients diagnosed with AKI were younger (4.3 vs 9.2 years; p=0.002) and had a higher BUN at admission (17 vs 15.2; p=0.035) than patients who did not develop AKI. Baseline clinical characteristics at admission, including ejection fraction and eGFR, did not differ between patients with persistent and transient AKI. A greater severity of kidney injury, as defined by pRIFLE was associated with persistent AKI. Treatment with inotropes (milrinone, epinephrine, or dopamine), diuretics, angiotensin converting enzyme inhibitors and mechanical ventilation were not different between the two groups. Thirty-one (23%) patients met the composite outcome: 21 died (2 on MCS) and 10 survived (all 10 on MCS). Patients with persistent AKI were more likely to meet the composite outcome of death or MCS than patients with transient AKI (80.6% vs 9.7%; p=0.003). On multivariable analysis, persistent AKI was independently associated with the composite outcome (OR 12.4; 95% CI 4.1-37.5, p< 0.001).
Conclusions: While AKI is common in children hospitalized with acute decompensated HF, trajectory of AKI has outcome implications. Persistent AKI is associated with death or the use of MCS.
Objectives: We sought to determine the prevalence, risk factors, and outcomes of transient and persistent AKI in children hospitalized with HF.
Methods: We performed a single center retrospective analysis of patients < 21 years old with acute decompensated HF admitted between 2011 to 2015. Patients with existing and new onset HF who required hospitalization for an exacerbation were included. Patients <3 months of age and those with a history of chronic kidney disease were excluded. AKI was defined as a decrease of > 25% in estimated glomerular filtration rate (eGFR) during hospitalization. A baseline eGFR of 100 was assumed, and those who presented with a eGFR of < 75 were deemed to have AKI at admission. AKI was classified as transient if it recovered within 48 hours of onset, all others were deemed persistent. Multiple episodes of AKI during hospitalization were reviewed for inclusion. The primary composite outcome was death within 60 days of hospitalization or the use of mechanical circulatory support (MCS) during hospitalization. Univariate analysis was conducted with chi square, fishers exact test, T-test, and Wilcoxon rank-sum test. Multivariable logistic regression was used to predict composite outcome.
Results: Of the 135 patients included in the analysis, 76 (56%) developed AKI with 52 (68.5%) meeting criteria for persistent AKI. Patients diagnosed with AKI were younger (4.3 vs 9.2 years; p=0.002) and had a higher BUN at admission (17 vs 15.2; p=0.035) than patients who did not develop AKI. Baseline clinical characteristics at admission, including ejection fraction and eGFR, did not differ between patients with persistent and transient AKI. A greater severity of kidney injury, as defined by pRIFLE was associated with persistent AKI. Treatment with inotropes (milrinone, epinephrine, or dopamine), diuretics, angiotensin converting enzyme inhibitors and mechanical ventilation were not different between the two groups. Thirty-one (23%) patients met the composite outcome: 21 died (2 on MCS) and 10 survived (all 10 on MCS). Patients with persistent AKI were more likely to meet the composite outcome of death or MCS than patients with transient AKI (80.6% vs 9.7%; p=0.003). On multivariable analysis, persistent AKI was independently associated with the composite outcome (OR 12.4; 95% CI 4.1-37.5, p< 0.001).
Conclusions: While AKI is common in children hospitalized with acute decompensated HF, trajectory of AKI has outcome implications. Persistent AKI is associated with death or the use of MCS.
Background: Acute kidney injury (AKI) occurs commonly in children hospitalized with heart failure (HF) and is strongly associated with worse clinical outcomes including death and need for mechanical circulatory support. Recent data in adults suggest that not all AKI in HF is the same. Patients with transient AKI, as opposed to those with persistent AKI, may have better outcomes. Data in pediatric HF, however, is lacking.
Objectives: We sought to determine the prevalence, risk factors, and outcomes of transient and persistent AKI in children hospitalized with HF.
Methods: We performed a single center retrospective analysis of patients < 21 years old with acute decompensated HF admitted between 2011 to 2015. Patients with existing and new onset HF who required hospitalization for an exacerbation were included. Patients <3 months of age and those with a history of chronic kidney disease were excluded. AKI was defined as a decrease of > 25% in estimated glomerular filtration rate (eGFR) during hospitalization. A baseline eGFR of 100 was assumed, and those who presented with a eGFR of < 75 were deemed to have AKI at admission. AKI was classified as transient if it recovered within 48 hours of onset, all others were deemed persistent. Multiple episodes of AKI during hospitalization were reviewed for inclusion. The primary composite outcome was death within 60 days of hospitalization or the use of mechanical circulatory support (MCS) during hospitalization. Univariate analysis was conducted with chi square, fishers exact test, T-test, and Wilcoxon rank-sum test. Multivariable logistic regression was used to predict composite outcome.
Results: Of the 135 patients included in the analysis, 76 (56%) developed AKI with 52 (68.5%) meeting criteria for persistent AKI. Patients diagnosed with AKI were younger (4.3 vs 9.2 years; p=0.002) and had a higher BUN at admission (17 vs 15.2; p=0.035) than patients who did not develop AKI. Baseline clinical characteristics at admission, including ejection fraction and eGFR, did not differ between patients with persistent and transient AKI. A greater severity of kidney injury, as defined by pRIFLE was associated with persistent AKI. Treatment with inotropes (milrinone, epinephrine, or dopamine), diuretics, angiotensin converting enzyme inhibitors and mechanical ventilation were not different between the two groups. Thirty-one (23%) patients met the composite outcome: 21 died (2 on MCS) and 10 survived (all 10 on MCS). Patients with persistent AKI were more likely to meet the composite outcome of death or MCS than patients with transient AKI (80.6% vs 9.7%; p=0.003). On multivariable analysis, persistent AKI was independently associated with the composite outcome (OR 12.4; 95% CI 4.1-37.5, p< 0.001).
Conclusions: While AKI is common in children hospitalized with acute decompensated HF, trajectory of AKI has outcome implications. Persistent AKI is associated with death or the use of MCS.
Objectives: We sought to determine the prevalence, risk factors, and outcomes of transient and persistent AKI in children hospitalized with HF.
Methods: We performed a single center retrospective analysis of patients < 21 years old with acute decompensated HF admitted between 2011 to 2015. Patients with existing and new onset HF who required hospitalization for an exacerbation were included. Patients <3 months of age and those with a history of chronic kidney disease were excluded. AKI was defined as a decrease of > 25% in estimated glomerular filtration rate (eGFR) during hospitalization. A baseline eGFR of 100 was assumed, and those who presented with a eGFR of < 75 were deemed to have AKI at admission. AKI was classified as transient if it recovered within 48 hours of onset, all others were deemed persistent. Multiple episodes of AKI during hospitalization were reviewed for inclusion. The primary composite outcome was death within 60 days of hospitalization or the use of mechanical circulatory support (MCS) during hospitalization. Univariate analysis was conducted with chi square, fishers exact test, T-test, and Wilcoxon rank-sum test. Multivariable logistic regression was used to predict composite outcome.
Results: Of the 135 patients included in the analysis, 76 (56%) developed AKI with 52 (68.5%) meeting criteria for persistent AKI. Patients diagnosed with AKI were younger (4.3 vs 9.2 years; p=0.002) and had a higher BUN at admission (17 vs 15.2; p=0.035) than patients who did not develop AKI. Baseline clinical characteristics at admission, including ejection fraction and eGFR, did not differ between patients with persistent and transient AKI. A greater severity of kidney injury, as defined by pRIFLE was associated with persistent AKI. Treatment with inotropes (milrinone, epinephrine, or dopamine), diuretics, angiotensin converting enzyme inhibitors and mechanical ventilation were not different between the two groups. Thirty-one (23%) patients met the composite outcome: 21 died (2 on MCS) and 10 survived (all 10 on MCS). Patients with persistent AKI were more likely to meet the composite outcome of death or MCS than patients with transient AKI (80.6% vs 9.7%; p=0.003). On multivariable analysis, persistent AKI was independently associated with the composite outcome (OR 12.4; 95% CI 4.1-37.5, p< 0.001).
Conclusions: While AKI is common in children hospitalized with acute decompensated HF, trajectory of AKI has outcome implications. Persistent AKI is associated with death or the use of MCS.
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