Long-term chronic kidney disease and hypertension in children previously admitted to the intensive care unit with and without acute kidney injury
Bibliographic record
Abstract
Acute kidney injury (AKI) is common in hospitalized children and associated with poor health outcomes. AKI leads to chronic kidney disease (CKD) and hypertension (HTN) in adults, however this association is unclear in children. CKD is associated with increased cardiovascular disease and currently, children admitted to the intensive care unit (ICU) are not being followed up for kidney function monitoring. Hypothesis: AKI during ICU stay increases long-term risk for CKD and HTN. Methods: An ongoing study of previously ICU-admitted children from Montreal and Edmonton identified by mailing and from participation in previous studies (exclusions: known pre-ICU renal disease, transplant, dialysis, geographical distance). Protocol: a study visit 6 years±6 months from ICU admission (blood, urine, physical exam, and clinical data collection). Outcomes: CKD (low estimated glomerular filtration rate [eGFR] or high urine albumin/creatinine ratio [ACR]), and pre-HTN or HTN (≥90th or ≥95th age-gender-height blood pressure percentile). The primary exposure is AKI during ICU. Results: 243 children were followed up 5.8+1.1 years post-ICU. Mean age of the study population was 10.6±5.6 years at follow-up. When assuming no AKI in patients without SCr measured during ICU stay, AKI incidence was 25%. At follow-up, 15.5% and 4.6% of all patients had pre-HTN and HTN, respectively. Composite outcome of CKD or pre-HTN in No AKI/AKI Stage 1 vs. AKI Stage 2 or 3 was 34% vs. 68% (p<0.05). Composite CKD or HTN in No AKI/AKI Stage 1 vs. AKI Stage 2 or 3 was 22% vs. 54% (p<0.05). Patients with AKI Stage 2 or 3 were more likely to develop CKD or pre-HTN (adjusted OR: 3.5. 95% confidence interval: 1.0-12.0). Conclusion: CKD and HTN are common 6 years post-ICU. Patients who develop Stage 2 or 3 AKI in ICU are at higher risk for developing long-term CKD or high blood pressure. This study will help create renal function follow-up guidelines for children after ICU stay.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".