Was the Van Eynde 2022 Acute Kidney Injury (AKI) meta-analysis confined to children?

Van Eynde 2022 AKI Meta-Analysis Was Not Confined to Children

The Van Eynde 2022 acute kidney injury meta-analysis was not confined to children, as it does not appear in the provided pediatric AKI literature.

Pediatric AKI Definitions and Considerations

• Pediatric AKI is primarily defined using the pediatric-modified RIFLE (pRIFLE) criteria, which was specifically developed to address the issues of applying adult AKI criteria to the pediatric population 1
• The pRIFLE criteria use estimated GFR (calculated using the original Schwartz equation), rise in creatinine, or decrease in urine output to stage AKI in children 1
• Unlike adult AKI definitions, pRIFLE allows for imputation of baseline kidney function when no prior creatinine is available, assuming a normal GFR of 100 ml/min/1.73 m² and using the patient's height 1
• Small changes in serum creatinine (0.3 mg/dL) may represent relatively large changes in actual GFR in pediatric patients compared to adults with underlying CKD 1

Differences Between Pediatric and Adult AKI

• The KDIGO guidelines refer to pRIFLE for the definition of AKI in children, acknowledging the need for separate criteria for the pediatric population 1
• There are significant differences between the KDIGO and pRIFLE criteria, requiring further validation before adoption of KDIGO criteria into pediatric research and practice 1
• Pediatric nephrologists may continue to apply the pRIFLE criteria rather than adopting new KDIGO AKI definitions due to these differences 1
• Measurement challenges exist in pediatrics, as accurate height measurement (needed for eGFR calculation using the Schwartz formula) can be difficult in sick, ventilated patients 1

Epidemiology and Causes of Pediatric AKI

• The causes of AKI differ significantly between high-income countries and low/lower-middle-income countries 1
• In high-income countries, pediatric AKI typically occurs in hospital settings secondary to cancer treatments, elective cardiac surgery, solid organ transplantation, or multiorgan failure 1
• In low/lower-middle-income countries, pediatric AKI is generally secondary to infections (e.g., acute gastroenteritis causing dehydration, postinfectious glomerulonephritis, severe malaria) or envenomation (snake and insect bites) 1
• AKI in low/lower-middle-income countries disproportionately affects children and adolescents and is associated with significant morbidity and mortality 1

Biomarkers in Pediatric AKI

• Novel biomarkers have been studied for earlier detection of AKI in children, with urinary neutrophil gelatinase-associated lipocalin (uNGAL) showing excellent diagnostic qualities in pediatric cardiac surgery patients 2
• The uNGAL-to-creatinine ratio yielded the highest diagnostic odds ratio in pediatric cardiac surgery patients, with a sensitivity of 91.3% and specificity of 89.7% 2
• Other promising biomarkers in pediatric AKI include liver fatty acid-binding protein (L-FABP), serum cystatin C, serum NGAL, and interleukin-18 2
• Despite promising biomarkers, more research is needed before these can be incorporated into routine clinical practice for pediatric AKI management 2

Clinical Significance of Pediatric AKI

• Acute kidney injury occurs in approximately 31.9% of pediatric cardiac surgery patients 3
• AKI in pediatric cardiac surgery patients is independently associated with increased occurrence of postoperative complications including low cardiac output syndrome, need for dialysis, and infection 3
• Pediatric patients with AKI have significantly longer duration of mechanical ventilation and length of intensive care unit stay compared to matched controls 3
• Long-term follow-up of individuals recovered from AKI is recommended, though the most effective models of care remain unclear 4