JAMA Pediatr. 2026 May 4. doi: 10.1001/jamapediatrics.2026.1357. Online ahead of print.
ABSTRACT
IMPORTANCE: Acute kidney injury (AKI) is a common complication among hospitalized children and may have lasting kidney and cardiovascular consequences. However, the long-term risks after pediatric AKI have not been comprehensively quantified.
OBJECTIVE: To estimate the pooled incidence and relative risk with odds ratio of chronic kidney disease (CKD), mortality, hypertension, and proteinuria following AKI in hospitalized children.
DATA SOURCES: PubMed, Embase, and Web of Science were searched from January 2007 through November 2025 without language restrictions.
STUDY SELECTION: Studies were included if they reported at least 1 long-term outcome (CKD, mortality, hypertension, or proteinuria) following AKI in hospitalized children. Studies limited to children with obstructive lesions, primary vascular disorders (eg, hemolytic uremic syndrome) or solid organ transplant were excluded.
DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias. Random-effects meta-analyses were performed to estimate pooled cumulative incidences and odds ratios (ORs) with 95% CIs.
MAIN OUTCOMES AND MEASURES: Cumulative incidence and odds of CKD, mortality, hypertension, and proteinuria following pediatric AKI.
RESULTS: Of 17 068 screened records, 39 studies comprising 16 151 participants were included. The pooled cumulative incidences following AKI were 17% (95% CI, 12-22) for CKD, 6% (95% CI, 3-8) for mortality, 20% (95% CI, 12-29) for proteinuria, and 16% (95% CI, 11-23) for hypertension. In 23 studies with non-AKI comparators and follow-up ranging from 3 months to 18 years, AKI was associated with increased odds of CKD (OR, 1.74; 95% CI, 1.02-2.95) and mortality (OR, 1.92; 95% CI, 1.35-2.75) but not proteinuria (OR, 1.18; 95% CI, 0.62-2.25) or hypertension (OR, 1.29; 95% CI, 0.72-2.31). Greater AKI severity was associated with a higher odds of CKD (stages 2-3: OR, 2.84; 95% CI, 1.49-4.15; stage 1: OR, 1.72; 95% CI, 1.11-2.67).
CONCLUSIONS AND RELEVANCE: The findings in this systematic review and meta-analysis demonstrate that, similar to adults, children experienced increased risk of late adverse outcomes following AKI, particularly CKD and mortality, supporting the need for structured post-AKI follow up.
PMID:42081220 | DOI:10.1001/jamapediatrics.2026.1357