Consensus-based recommendations for acute kidney injury in children

Acute kidney injury (AKI) occurs in children and young adults and can result in negative short- and long-term outcomes. To understand how to expand knowledge of pediatric AKI worldwide, the Acute Disease Quality Initiative (ADQI), a leading group of intensivists and nephrologists who are key opinion leaders in the landscape of critical care nephrology, developed a consensus statement that was published in JAMA Network Open.
 
“We anticipate that this is going to be agenda-defining for the foreseeable future for the field of pediatric critical care in nephrology and further research into acute kidney injury,” said Dr. Ayse Akcan-Arikan, chair of the meeting and associate professor in the Department of Pediatrics – divisions of critical care medicine and nephrology at Baylor College of Medicine and Texas Children’s Hospital. “We are moving the needle in detecting it, treating it and mitigating it better so we can improve overall pediatric healthcare.”
 
While the past consensus conferences have included pediatric implementation, childhood illness related to kidney diseases and acute kidney injury was not the sole topic until the ADQI meeting conducted in November 2021.
 
The researchers developed six summary statements that address what is needed to provide optimal care:
 
•    Epidemiology
•    Diagnostics approaches
•    Fluid balance and fluid management
•    Kidney support therapy
•    Pathobiology and nutrition and pharmacology consideration
•    Education and advocacy
 
“The summary statement points the field in the direction for what needs to be done next in order to be able to bring epidemiology and knowledge to the bedside, measure and describe fluid balance better, provide a personal approach to diagnosis and monitoring, understand the implications in what happens in early childhood in terms of longitudinal health outcomes, partner with innovation stakeholders to encourage better age-appropriate machines for smaller patients, and provide targeted advocacy and education,” Akcan-Arikan said.
 
After two decades of work in pediatric critical care nephrology, the conference has created a tangible foundation for future AKI research, education and advocacy for those who work in critical care nephrology and the population impacted with acute kidney disease, she said.