AKI in children hospitalized with nephrotic syndrome

Midwest Pediatric Nephrology Consortium

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition. ResultsAKI occurred in 58.6%of 336 children and 50.9%of 615 hospitalizations (27.3%in stage R, 17.2%in stage I, and 6.3%in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P,0.001). Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.

Original languageEnglish (US)
Pages (from-to)2110-2118
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number12
DOIs
StatePublished - Dec 7 2015

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Hospitalized Child
Nephrotic Syndrome
Confidence Intervals
Odds Ratio
Infection
Length of Stay
Epidemiology
Hospitalization
Pediatrics
Nephrology
Venous Thromboembolism
North America
Intensive Care Units
Thrombosis
Steroids
Incidence

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

AKI in children hospitalized with nephrotic syndrome. / Midwest Pediatric Nephrology Consortium.

In: Clinical Journal of the American Society of Nephrology, Vol. 10, No. 12, 07.12.2015, p. 2110-2118.

Research output: Contribution to journalArticle

Midwest Pediatric Nephrology Consortium. / AKI in children hospitalized with nephrotic syndrome. In: Clinical Journal of the American Society of Nephrology. 2015 ; Vol. 10, No. 12. pp. 2110-2118.
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title = "AKI in children hospitalized with nephrotic syndrome",
abstract = "Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition. ResultsAKI occurred in 58.6{\%}of 336 children and 50.9{\%}of 615 hospitalizations (27.3{\%}in stage R, 17.2{\%}in stage I, and 6.3{\%}in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95{\%} confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95{\%} confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95{\%} confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95{\%} confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38{\%} higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95{\%} confidence interval, 0.36 to 0.53 [log]days; P,0.001). Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.",
author = "{Midwest Pediatric Nephrology Consortium} and Rheault, {Michelle N.} and Lei Zhang and Selewski, {David T.} and Mahmoud Kallash and Tran, {Cheryl L.} and Meredith Seamon and Chryso Katsoufis and Isa Ashoor and Joel Hernandez and Katarina Supe-Markovina and Cynthia D’alessandri-Silva and Nilka Dejesus-Gonzalez and Vasylyeva, {Tetyana L.} and Cassandra Formeck and Christopher Woll and Rasheed Gbadegesin and Pavel Geier and Prasad Devarajan and Carpenter, {Shannon L.} and Kerlin, {Bryce A.} and Smoyer, {William E.}",
year = "2015",
month = "12",
day = "7",
doi = "10.2215/CJN.06620615",
language = "English (US)",
volume = "10",
pages = "2110--2118",
journal = "Clinical journal of the American Society of Nephrology : CJASN",
issn = "1555-9041",
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number = "12",

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TY - JOUR

T1 - AKI in children hospitalized with nephrotic syndrome

AU - Midwest Pediatric Nephrology Consortium

AU - Rheault, Michelle N.

AU - Zhang, Lei

AU - Selewski, David T.

AU - Kallash, Mahmoud

AU - Tran, Cheryl L.

AU - Seamon, Meredith

AU - Katsoufis, Chryso

AU - Ashoor, Isa

AU - Hernandez, Joel

AU - Supe-Markovina, Katarina

AU - D’alessandri-Silva, Cynthia

AU - Dejesus-Gonzalez, Nilka

AU - Vasylyeva, Tetyana L.

AU - Formeck, Cassandra

AU - Woll, Christopher

AU - Gbadegesin, Rasheed

AU - Geier, Pavel

AU - Devarajan, Prasad

AU - Carpenter, Shannon L.

AU - Kerlin, Bryce A.

AU - Smoyer, William E.

PY - 2015/12/7

Y1 - 2015/12/7

N2 - Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition. ResultsAKI occurred in 58.6%of 336 children and 50.9%of 615 hospitalizations (27.3%in stage R, 17.2%in stage I, and 6.3%in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P,0.001). Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.

AB - Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition. ResultsAKI occurred in 58.6%of 336 children and 50.9%of 615 hospitalizations (27.3%in stage R, 17.2%in stage I, and 6.3%in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P,0.001). Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.

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JO - Clinical journal of the American Society of Nephrology : CJASN

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SN - 1555-9041

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