Browsing by Author "Zappitelli, Michael"

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    Acute kidney injury in critically Ill children and young adults with suspected SARS-CoV2 infection
    (Springer Nature, 2022-06) Basu, Rajit K.; Bjornstad, Erica C.; Gist, Katja M.; Starr, Michelle; Khandhar, Paras; Chanchlani, Rahul; Krallman, Kelli A.; Zappitelli, Michael; Askenazi, David; Goldstein, Stuart L.; Pediatrics, School of Medicine
    Background: We aimed to study the association of suspected versus confirmed infection with the novel SARS-CoV2 virus with the prevalence of acute kidney injury (AKI) in critically ill children. Methods: Sequential point-prevalence study of children and young adults aged 7 days to 25 years admitted to intensive care units under investigation for SARS-CoV2 infection. AKI was staged in the first 14 days of enrollment using KDIGO creatinine-based staging. SARS-CoV2 positive (CONFIRMED) were compared to SUSPECTED (negative or unknown). Outcome data was censored at 28-days. Results: In 331 patients of both sexes, 179 (54.1%) were CONFIRMED, 4.2% (14) died. AKI occurred in 124 (37.5%) and severe AKI occurred in 63 (19.0%). Incidence of AKI in CONFIRMED was 74/179 (41.3%) versus 50/152 (32.9%) for SUSPECTED; severe AKI occurred in 35 (19.6%) of CONFIRMED and 28 (18.4%) of SUSPECTED. Mortality was 6.2% (n = 11) in CONFIRMED, but 9.5% (n = 7) in those CONFIRMED with AKI. On multivariable analysis, only Hispanic ethnicity (relative risk 0.5, 95% CI 0.3-0.9) was associated with less AKI development among those CONFIRMED. Conclusions: AKI and severe AKI occur commonly in critically ill children with SARS-CoV2 infection, more than double the historical standard. Further investigation is needed during this continuing pandemic to describe and refine the understanding of pediatric AKI epidemiology and outcomes. Trial registration: NCT01987921. Impact: What is the key message of the article? AKI occurs in children exposed to the novel SARS-CoV2 virus at high prevalence (~40% with some form of AKI and 20% with severe AKI). What does it add to the existing literature? Acute kidney injury (AKI) occurs commonly in adult patients with SARS-CoV2 (COVID), very little data describes the epidemiology of AKI in children exposed to the virus. What is the impact? A pediatric vaccine is not available; thus, the pandemic is not over for children. Pediatricians will need to manage significant end-organ ramifications of the novel SARS-CoV2 virus including AKI.
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    Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children: A Modified Delphi Consensus Statement
    (American Medical Association, 2022-09-01) Goldstein, Stuart L.; Akcan-Arikan, Ayse; Alobaidi, Rashid; Askenazi, David J.; Bagshaw, Sean M.; Barhight, Matthew; Barreto, Erin; Bayrakci, Benan; Bignall, Orville N. R.; Bjornstad, Erica; Brophy, Patrick D.; Chanchlani, Rahul; Charlton, Jennifer R.; Conroy, Andrea L.; Deep, Akash; Devarajan, Prasad; Dolan, Kristin; Fuhrman, Dana Y.; Gist, Katja M.; Gorga, Stephen M.; Greenberg, Jason H.; Hasson, Denise; Heydari Ulrich, Emma; Iyengar, Arpana; Jetton, Jennifer G.; Krawczeski, Catherine; Meigs, Leslie; Menon, Shina; Morgan, Jolyn; Morgan, Catherine J.; Mottes, Theresa; Neumayr, Tara M.; Ricci, Zaccaria; Selewski, David; Soranno, Danielle E.; Starr, Michelle; Stanski, Natalja L.; Sutherland, Scott M.; Symons, Jordan; Tavares, Marcelo S.; Wong Vega, Molly; Zappitelli, Michael; Ronco, Claudio; Mehta, Ravindra L.; Kellum, John; Ostermann, Marlies; Basu, Rajit K.; Pediatric ADQI Collaborative; Pediatrics, School of Medicine
    Importance: Increasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge. Objective: To develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy. Evidence review: At the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations. Findings: The meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy. Conclusions and relevance: Existing evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.
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    Editorial: Acute Kidney Injury: It's Not Just Acute, and It's Not Just the Kidneys
    (Frontiers Media, 2021-11-15) Soranno, Danielle E.; Deep, Akash; Gist, Katja M.; Zappitelli, Michael; Pediatrics, School of Medicine
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    Pediatric AKI in the real world: changing outcomes through education and advocacy-a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference
    (Springer, 2024) Mottes, Theresa; Menon, Shina; Conroy, Andrea; Jetton, Jennifer; Dolan, Kristin; Arikan, Ayse Akcan; Basu, Rajit K.; Goldstein, Stuart L.; Symons, Jordan M.; Alobaid, Rashid; Askenazi, David J.; Bagshaw, Sean M.; Barhight, Matthew; Barreto, Erin; Bayrakci, Benan; Bignall, O. N., II; Bjornstad, Erica; Brophy, Patrick; Charlton, Jennifer; Chanchlani, Rahul; Conroy, Andrea L.; Deep, Akash; Devarajan, Prasad; Fuhrman, Dana; Gist, Katja M.; Gorga, Stephen M.; Greenberg, Jason H.; Hasson, Denise; Heydari, Emma; Iyengar, Arpana; Krawczeski, Catherine; Meigs, Leslie; Morgan, Catherine; Morgan, Jolyn; Neumayr, Tara; Ricci, Zaccaria; Selewski, David T.; Soranno, Danielle; Stanski, Natalja; Starr, Michelle; Sutherland, Scott M.; Symons, Jordan; Tavares, Marcelo; Vega, Molly; Zappitelli, Michael; Ronco, Claudio; Mehta, Ravindra L.; Kellum, John; Ostermann, Marlies; ADQI 26 workgroup; Pediatrics, School of Medicine
    Background: Acute kidney injury (AKI) is independently associated with increased morbidity and mortality across the life course, yet care for AKI remains mostly supportive. Raising awareness of this life-threatening clinical syndrome through education and advocacy efforts is the key to improving patient outcomes. Here, we describe the unique roles education and advocacy play in the care of children with AKI, discuss the importance of customizing educational outreach efforts to individual groups and contexts, and highlight the opportunities created through innovations and partnerships to optimize lifelong health outcomes. Methods: During the 26th Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations on AKI research, education, practice, and advocacy in children. Results: The consensus statements developed in response to three critical questions about the role of education and advocacy in pediatric AKI care are presented here along with a summary of available evidence and recommendations for both clinical care and research. Conclusions: These consensus statements emphasize that high-quality care for patients with AKI begins in the community with education and awareness campaigns to identify those at risk for AKI. Education is the key across all healthcare and non-healthcare settings to enhance early diagnosis and develop mitigation strategies, thereby improving outcomes for children with AKI. Strong advocacy efforts are essential for implementing these programs and building critical collaborations across all stakeholders and settings.