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Secular Trends in Incidence, Modality and Mortality with Dialysis Receiving AKI in Children in Ontario: A Population-Based Cohort Study.

  • Chanchlani, Rahul1, 2
  • Nash, Danielle Marie3
  • McArthur, Eric3
  • Zappitelli, Michael4
  • Archer, Victoria5
  • Kuwornu, John Paul3
  • Garg, Amit X3
  • Greenberg, Jason H6
  • Goldstein, Stuart L7
  • Thabane, Lehana2, 8, 9, 10
  • Wald, Ron11
  • 1 Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children Hospital, Hamilton, Canada; [email protected] , (Canada)
  • 2 Department of Health Research Methods, Evidence, and Impact.
  • 3 ICES, Ontario, Canada. , (Canada)
  • 4 Division of Pediatric Nephrology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada. , (Canada)
  • 5 Michael DeGroote School of Medicine.
  • 6 Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut.
  • 7 Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, Ohio.
  • 8 Department of Pediatrics, and.
  • 9 Department of Anesthesia, McMaster University, Hamilton, Canada. , (Canada)
  • 10 Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada; and. , (Canada)
  • 11 Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada. , (Canada)
Published Article
Clinical Journal of the American Society of Nephrology
American Society of Nephrology
Publication Date
Sep 06, 2019
DOI: 10.2215/CJN.08250718
PMID: 31444174


There is a limited appreciation of the epidemiology of dialysis-receiving AKI in children. The primary objective of the study was to evaluate changes in the incidence of dialysis-receiving AKI among children over a period of 20 years in Ontario, Canada. The secondary objectives were to assess temporal trends in the utilization of various dialysis modalities and 30-day mortality among children with dialysis-receiving AKI. All children (29 days to 18 years) who received their first dialysis for AKI between 1996 and 2015 were identified from healthcare administrative databases. Those who received dialysis for ESKD, inborn errors of metabolism, and poisonings were excluded. The incidence rates of dialysis-receiving AKI were reported annually. The Cochran-Armitage test was used to assess trends in the incidence and short-term mortality after dialysis-receiving AKI. We identified 1394 children treated with dialysis for AKI during a hospital stay. There was a significant increase in the incidence of dialysis-receiving AKI among hospitalized children from 1996 (0.58 per 1000 person-years) to 2015 (0.65 per 1000 person-years) (P=0.01). The use of continuous kidney replacement therapy and intermittent hemodialysis increased whereas the relative use of peritoneal dialysis declined over time. Thirty-day mortality rates after dialysis-receiving AKI increased from 14% to 25% between 1996 and 2009 and reduced to 19% in the more recent years (P=0.03). In Ontario, the incidence of dialysis-receiving AKI among children has increased between 1996 and 2015. The use of peritoneal dialysis for AKI has declined and the short-term mortality after dialysis-receiving AKI has increased. Copyright © 2019 by the American Society of Nephrology.

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