CHILDREN who experience acute kidney injury (AKI) during hospitalisation face significantly increased long-term risks of chronic kidney disease (CKD) and mortality, reinforcing calls for structured follow-up care after discharge, according to a new systematic review and meta-analysis.
Large Meta-Analysis Examines Long-Term Outcomes After Paediatric AKI
The study analysed data from 39 studies involving more than 16,000 paediatric patients. The review is among the most comprehensive assessments to date of late outcomes following AKI in children.
AKI is a common complication in critically ill or hospitalised children and is characterised by a sudden decline in kidney function. While its short-term consequences are well recognised, evidence surrounding longer-term complications in paediatric populations has remained limited.
Pooling data from studies published between 2007 and 2025, the investigators examined the incidence of CKD, mortality, hypertension, and proteinuria after AKI. They found that 17% of children developed CKD following AKI, while 6% died during follow-up. Proteinuria and hypertension were also common, affecting 20% and 16% of patients, respectively.
Severe AKI Associated with Greater Long-Term Kidney Damage
Importantly, when compared with children who had not experienced AKI, survivors of paediatric AKI had a 74% higher odds of developing CKD and nearly double the odds of late mortality. The risk appeared greatest among children with more severe AKI, with stage 2–3 injury associated with substantially higher odds of CKD than stage 1 disease.
Although AKI was associated with increased rates of hypertension and proteinuria overall, the meta-analysis did not demonstrate statistically significant differences for these outcomes when non-AKI comparator groups were included.
The authors noted considerable variability across studies, including differences in follow-up duration, definitions of kidney outcomes, and patient populations. Nevertheless, they concluded that the findings align with growing evidence from adult studies suggesting AKI may have lasting systemic consequences beyond the initial hospital admission.
Findings Support Structured Post-AKI Follow-Up in Children
The researchers said the results support routine long-term kidney surveillance after paediatric AKI, particularly in children with moderate to severe injury. They also highlighted the need for prospective studies to determine optimal monitoring strategies and interventions that could reduce progression to CKD later in life.
Reference
Meena J et al. Late Outcomes Following Acute Kidney Injury in Children: A Systematic Review and Meta-Analysis. JAMA Pediatr. 2026;DOI: 10.1001/jamapediatrics.2026.1357.
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