Katja Gist, DO: Pediatric Patients Overlooked in Nephrology

Children undergoing cardiac surgery are often at an elevated risk of developing acute kidney injuries.

However, during the American Society of Nephrology (ASN) Kidney Week in Washington, D.C., investigators presented the Modified Renal Angina Index, a new tool that helps predict poor outcomes in this patient population.

In an interview with MD Magazine®, Katja Gist, assistant professor of Cardiology-Pediatrics at the University of Colorado School of Medicine, explained how this new tool will help patients and why pediatrics is often an overlooked segment of nephrology.

MD Magazine: What is the impetus behind the study?

Gist: So, acute kidney injury is a common complication after pediatric cardiac surgery with an incidence ranging of around 20-40%. It is well known that aside from acute kidney injury, the complications that can incur are significant including a duration of prolonged mechanical ventilation and death.

The renal angina index was derived for use as a clinical tool in critically ill children to predict acute kidney injury.

The impetus for the current study was to derive and validate the renal angina index specific for children who are undergoing cardiac surgery to be able to better predict their risk for poor outcome.

In this particular study, we derived the outcome as not only acute kidney injury but also acute kidney injury related complications including a prolonged duration of mechanical ventilation greater than 5 days and/or death.

MD Magazine: What do you believe the impact of the study will be?

Gist: The way this particular tool was derived allows one to predict by 8 hours after cardiac surgery whether or not the patient is going to have an untoward outcome. The composite outcome that I previously mentioned of acute kidney injury on the third day after cardiac surgery being on the ventilator greater than or equal to 5 days or death.

So, at a time point very soon after cardiac surgery we would know the risk that a patient would incur for having 1 of those particular outcomes.

So, it would help clinicians to be able to better determine and potentially modify the treatment course for their patient in knowing that they might be at risk for this bad outcome.

MD Magazine: Do you believe pediatric patients are overlooked in nephrology?

Gist: I absolutely agree that pediatric patients are generally overlooked. Oftentimes they're considered to be small adults, but the long-standing effects of having an episode of acute kidney injury are significant.

These patients may get into adulthood and there's been numerous studies that have now demonstrated a risk for chronic kidney disease. So, while they may be able to recover their episode of acute kidney injury in the hospital, we don't want to forget about these patients because these may be the ones in who in adulthood are needing dialysis.