Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children: A Modified Delphi Consensus Statement

Stuart L. Goldstein, Ayse Akcan-Arikan, Rashid Alobaidi, David J. Askenazi, Sean M. Bagshaw, Matthew Barhight, Erin Barreto, Benan Bayrakci, Orville N.R. Bignall, Erica Bjornstad, Patrick D. Brophy, Rahul Chanchlani, Jennifer R. Charlton, Andrea L. Conroy, Akash Deep, Prasad Devarajan, Kristin Dolan, Dana Y. Fuhrman, Katja M. Gist, Stephen M. GorgaJason H. Greenberg, Denise Hasson, Emma Heydari Ulrich, Arpana Iyengar, Jennifer G. Jetton, Catherine Krawczeski, Leslie Meigs, Shina Menon, Jolyn Morgan, Catherine J. Morgan, Theresa Mottes, Tara M. Neumayr, Zaccaria Ricci, David Selewski, Danielle E. Soranno, Michelle Starr, Natalja L. Stanski, Scott M. Sutherland, Jordan Symons, Marcelo S. Tavares, Molly Wong Vega, Michael Zappitelli, Claudio Ronco, Ravindra L. Mehta, John Kellum, Marlies Ostermann, Rajit K. Basu*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

66 Scopus citations


Importance: Increasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge. Objective: To develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy. Evidence Review: At the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations. Findings: The meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy. Conclusions and Relevance: Existing evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts..

Original languageEnglish (US)
Pages (from-to)E2229442
JournalJAMA network open
Issue number9
StatePublished - Sep 30 2022

ASJC Scopus subject areas

  • General Medicine


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