Kids’ Acute Kidney Injury Linked to These Lasting Health Risks

Kids who had acute kidney injury (AKI) during a hospitalization often experienced lasting health consequences, a meta-analysis showed.

Pooled cumulative incidences were 17% for chronic kidney disease (CKD), 6% for mortality, 20% for proteinuria, and 16% for hypertension, researchers led by Rahul Chanchlani, MD, MSc, of McMaster Children’s Hospital in Hamilton, Ontario, reported in JAMA Pediatrics.

In studies comparing outcomes with children who didn’t have AKI, the odds of CKD were 1.74-fold higher after AKI (95% CI 1.02-2.95). And despite few studies and low certainty evidence, AKI in kids also was associated with nearly doubled odds of mortality (OR 1.92, 95% CI 1.35-2.75) with a range of follow-up from 3 months to 18 years.

“AKI in a child is not a self-contained acute event, it is the start of long-term health issues that require ongoing monitoring,” Chanchlani told MedPage Today in an email. “Clinicians should shift their perception of childhood AKI from something that resolves on discharge to a risk factor for CKD that may persist for decades.”

Pediatric nephrologist Shina Menon, MD, of Stanford Medicine Children’s Health in California, who was not involved in the study, agreed with the researchers on the need for structured post-AKI follow-up for these health consequences.

“We also need to start thinking about where this follow-up will be done (at the primary care provider or nephrologist or subspecialist clinic), and who should be followed up (at minimum those with moderate or severe AKI),” Menon told MedPage Today in an email.

Findings of the current study “have critical implications for clinical care and healthcare policy,” Chanchlani and colleagues contended. “Children surviving AKI represent a unique cohort with a prolonged lifetime risk of adverse outcomes, particularly CKD and its associated healthcare burden and costs.”

While the findings largely match those seen in adults, Chanchlani’s team did not find statistically significant increased odds of proteinuria or hypertension in the AKI survivors compared with other children.

The latter finding “contrasts with adult data and was somewhat surprising, though there is a plausible explanation: children may have pediatric-specific kidney recovery mechanisms, or follow-up periods in the included studies may simply not have been long enough to capture late-onset hypertension and proteinuria,” Chanchlani said. “This is an important unanswered question that warrants further study.”

AKI is common in hospitalized infants and kids, and in the acute phase, is linked to increased mortality, longer stays, and greater need for mechanical ventilation, Chanchlani and colleagues noted in JAMA Pediatrics. Recently, “harmonization of AKI definitions has improved comparability across studies, advancing insights into its long-term effects.” However, though adult data have demonstrated an association between AKI and adverse outcomes, data in the pediatric population have remained limited.

The meta-analysis included 39 studies published from January 2007 through November 2025 that reported at least one long-term outcome (CKD, mortality, hypertension, or proteinuria) following AKI sustained during hospitalization in a total of 16,151 children. And 23 studies with non-AKI comparators and follow-up ranging from 3 months to 18 years were used to glean odds ratios for late adverse outcomes.

Greater AKI severity was associated with greater risk of CKD. Odds ratios went from 1.72 for stage 1 AKI to 2.84 for AKI stages 2 and 3.

“Since the risk of long-term harm is associated with AKI severity, anything that prevents AKI from occurring or stops mild AKI from progressing to severe AKI could meaningfully reduce future CKD and mortality burden,” Chanchlani said.

“Practically, this means vigilance around nephrotoxic medication exposure (a key modifiable risk factor), aggressive fluid management, and hemodynamic stabilization in high-risk settings like pediatric intensive care units and cardiac surgery units, and minimizing unnecessary nephrotoxic drug use,” he said.

Additionally, “optimal post-AKI care is critical, including optimizing blood pressure, avoiding further nephrotoxic exposures, and promoting healthy lifestyle habits (diet, hydration, avoiding NSAIDs) may collectively slow or prevent CKD progression,” he continued. “Given that the lifetime healthcare burden from pediatric AKI sequelae is likely significant, especially in resource-limited settings, there is a strong argument to develop formal post-AKI surveillance pathways for children.”

Limitations of the meta-analysis included that heterogeneity observed in CKD and other outcomes reflected variability in study design, in study population outcome definitions, and in follow-up durations. About one-third of studies had 1 year or less of follow-up, and nearly 80% had 5 years or less of follow-up, “restricting assessment of late kidney outcomes,” Chanchlani and colleagues noted.

Also, a limited number of studies examined mortality, proteinuria, and hypertension. And, simplistic categorization of AKI might have obscured differences related to underlying cause, course, and recovery pattern.