Abstract
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 language | English (US) |
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Pages (from-to) | E2229442 |
Journal | JAMA network open |
Volume | 5 |
Issue number | 9 |
DOIs | |
State | Published - Sep 30 2022 |
Funding
Conflict of Interest Disclosures: Dr Goldstein reported receiving personal fees from BioPorto Diagnostics, grant support and personal fees from Medtronic Inc, NuWellis Inc, Leadiant, personal fees from MediBeacon Inc, stock options and personal fees from Baxter Healthcare, grant support and personal fees from SeaStar Medical, and grants from ExThera Medical outside the submitted work. Dr Akcan-Arikan reported receiving financial support for research from Bioporto research funds paid to her institution outside the submitted work. Dr Askenazi reported receiving personal fees from Baxter, Nuwellis, Medtronic, Seastar, and Bioporto, and financial support for research from Zorro-Flow outside the submitted work; in addition, Dr Askenazi reported having a patent for Zorro-Flow, an external urine collection device pending, and a patent for continuous renal replacement therapy (CRRT) advancements pending. Dr Bagshaw reported receiving personal fees from Baxter and BioPorto during the conduct of the study. Dr Barreto reported receiving financial support for research from FAST Biomedical Consultant and Wolters-Kluwer Consultant outside the submitted work. Dr Brophy reported receiving personal fees from UpToDate during the conduct of the study and American Board of Medical Specialities finance board. Dr Charlton reported receiving personal fees from Medtronics Carpediem Clinical Events Committee outside the submitted work. Dr Devarajan reported receiving grants from National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study; holding a patent as co-inventor on patents licensed to Abbott Diagnostics and BioPorto Inc, on use of neutrophil gelatinase-associated lipocalin as a biomarker of kidney injury. Dr Gist reported receiving financial support for research from Medtronic Speaker Honorarium and financial support for research from Bioporto Diagnostics consulting fees outside the submitted work. Dr Menon reported receiving personal fees from Nuwellis Inc outside the submitted work. Dr J. Morgan reported receiving personal fees from Medtronic Consultant outside the submitted work. Dr Mottes reported receiving financial support for research from Medtronic outside the submitted work. Dr Stanski reported receiving grants from National Center for Advancing Translational Sciences of the National Institutes of Health Institutional CT2 grant, 2UL1TR001425-05A1 and travel reimbursement from pADQI Travel funds to travel to consensus meeting (flight and hotel) during the conduct of the study; in addition, Dr Stanski reported holding a patent for PERSEVERE-II AKI Prediction Model pending. Dr Zappitelli reported receiving financial support for research from Bioporto Inc adjudicator/consultant for a study on neutrophil gelatinase-associated lipocalin and financial support for research from Baxter Inc Honorarium for a national talk on CRRT (not viewed by company ahead of time) outside the submitted work. Dr Kellum reported receiving personal fees from Dialco; being an employee of Spectral Medical and its wholly owned subsidiary Dialco outside the submitted work; and paid consultant for Astute Medical. Dr Ostermann reported receiving grants from Fresenius Research funding, grants from Baxter Research funding, and grants from Biomerieux Research funding during the conduct of the study. Dr Basu reported receiving personal fees from Bioporto Diagnostics outside of the submitted work. and personal fees from BioMerieux outside of the submitted work. during the conduct of the study; in addition, Dr Basu reported having a patent for Renal Angina Index pending outside of the submitted work. and a patent for olfactomedin-4 pending outside of the submitted work. No other disclosures were reported.
ASJC Scopus subject areas
- General Medicine