Late Outcomes After Pediatric Acute Kidney Injury

Key Takeaways

• Pooled incidences after AKI were 17% for CKD, 6% for mortality, 20% for proteinuria, and 16% for hypertension.
• Across 23 comparator studies with follow-up from 3 months to 18 years, AKI was associated with higher odds of CKD and mortality, but not proteinuria or hypertension.
• More severe AKI was associated with higher odds of CKD, and the authors said the findings support structured post-AKI follow-up.

A pooled analysis found that 17% of hospitalized children had chronic kidney disease after acute kidney injury, alongside other late renal and nonrenal outcomes. In a systematic review and meta-analysis published online May 4, 2026, in JAMA Pediatrics, investigators examined long-term outcomes after pediatric AKI. The review focused on hospitalized children and used consensus exposure definitions across included studies. It assessed outcomes occurring after the index hospitalization during follow-up. Across the available evidence, pediatric AKI was associated with later kidney outcomes and higher late mortality.

The systematic review and meta-analysis included 39 cohort studies and 16,151 participants hospitalized during childhood. Researchers searched PubMed, Embase, and Web of Science from January 2007 through November 2025 without language restrictions. They excluded studies limited to obstructive lesions, primary vascular disorders such as hemolytic uremic syndrome, or solid organ transplant. Two reviewers independently extracted data and assessed risk of bias, and random-effects models were used to estimate pooled incidences and odds ratios. The review examined late renal and nonrenal outcomes after AKI in hospitalized children.

After AKI, the pooled cumulative incidence of CKD was 17% (95% CI, 12-22), while mortality was 6% (95% CI, 3-8). Proteinuria had a pooled incidence of 20% (95% CI, 12-29), and hypertension had a pooled incidence of 16% (95% CI, 11-23). These estimates reflect outcomes observed after pediatric AKI within the included cohorts rather than background risks in children generally. The pattern included late kidney findings alongside measurable mortality and blood pressure abnormalities.

In 23 studies with non-AKI comparators, follow-up ranged from 3 months to 18 years. AKI was associated with higher odds of CKD (OR, 1.74; 95% CI, 1.02-2.95). Late mortality was also higher in children with AKI (OR, 1.92; 95% CI, 1.35-2.75). Comparator analyses did not show associations for proteinuria (OR, 1.18; 95% CI, 0.62-2.25) or hypertension (OR, 1.29; 95% CI, 0.72-2.31). CKD odds rose with severity, from stage 1 AKI (OR, 1.72; 95% CI, 1.11-2.67) to stages 2-3 (OR, 2.84; 95% CI, 1.49-4.15), with CKD and mortality standing out most clearly in comparative analyses.

The authors concluded that these findings support structured post-AKI follow-up in children. That conclusion was based on the observed late burden of CKD and mortality across hospitalized cohorts. It did not extend beyond the populations represented in the review's eligibility criteria, which excluded studies restricted to obstructive lesions, primary vascular disorders, or solid organ transplant. Within that scope, the review linked pediatric AKI with later kidney outcomes and measurable late mortality.