The Kidney Foundation of Canada

Dr. Michael Zappitelli 

Dr. Michael Zappitelli

McGill University Health Centre Research Institute, Quebec

11-year renal outcomes after pediatric intensive care unit admission: acute kidney injury and disease progression


2017-2019: $100,000 | Category: Screening & Prevention of Renal Disease

Biography

Dr. Michael Zappitelli, is a pediatric nephrology fellow who obtained his MD at McGill University in Montreal and completed a Post-doctoral Fellowship with Dr. Stuart Goldstein at Baylor College of Medicine and Texas Children’s Hospital in Houston, one of the largest pediatric centres in North America.

His research is on acute kidney injury (AKI) in children. AKI mostly occurs in hospitalized patients and must be better understood in order to detect the disease earlier, lessen the most serious risks and improve patients’ long-term health. His clinical research laboratory is characterizing this disease by evaluating definitions and performing studies to assess the effect of AKI on various outcomes in several diagnostic populations. Included are patients on nephrotoxic medications, patients undergoing cardiac surgery and critically ill patients. His latest studies examine the long-term outcomes of AKI in cardiac and non-cardiac critically ill patients and in children treated for cancer with cisplatin. He aims to evaluate whether AKI is a risk factor for chronic kidney disease (CKD) and whether new AKI biomarkers of renal tubular damage can be used to better diagnose patients at risk of CKD. Other projects focus on discovering and characterizing novel AKI urine protein biomarkers for AKI diagnosis.

Lay Summary

Many critically ill children admitted to the intensive care unit (ICU) experience injury to their kidneys, or what is referred to as acute kidney injury (AKI). AKI usually happens because of the disease which brought children to the ICU (e.g., severe infection, cardiac surgery) or the treatments they need to receive (e.g., medication toxic to kidneys). AKI can cause many problems, like fluid retention with heart failure, hormone problems, difficulty feeding and sometimes AKI requires treatment with dialysis. In children, we know that AKI in ICU children is associated with death in the ICU and longer hospital stay.

In adults, it is known that kidney tissue damage occurring with AKI can lead to chronic (long-term, ongoing) kidney damage. This long-term damage can lead to chronic kidney disease or high blood pressure (hypertension) and even increase risk for long-term death in adults. However, little is known about how AKI which occurs in hospitalized children, affects long term child kidney health. Chronic kidney disease and hypertension are a significant burden to populations and are very important risk factors for heart disease. Early life events like AKI may be an important risk factor for chronic kidney disease and hypertension in children. Importantly, early treatment and prevention of chronic kidney disease and hypertension in children could lead to significant improvements in kidney and heart health and decrease health system burden.
 
To begin clarifying if AKI in children admitted to the ICU leads to chronic kidney disease or hypertension, we previously studied a group of children, 6 years after they were in the ICU. Chronic kidney disease and hypertension were remarkably common. Yet, we know that most children who are admitted to the ICU are not followed up for kidney function or blood pressure problems after discharge from hospital. Therefore, chronic kidney disease and hypertension in our group of children would have otherwise gone undetected. There is a need to change how ICU children are followed-up after discharge, to detect, prevent and treat chronic kidney disease and hypertension. We will follow-up our large group of children previously admitted to the ICU (whom we followed already at 6 years after ICU admission), at 11 years after ICU admission. We will do this to understand if and by how much kidney function, kidney damage or blood pressure worsen over time, from 6 to 11 years after ICU admission. We will also study whether new urine tests of kidney damage measured in children at 6 years after ICU admission can help us predict what children will have worsening, or improving, kidney function and blood pressure at 11 years follow-up. This study will be unique in the world and will give us the information we need to start changing how children are followed up and treated by their doctors, and tell us what children need to be followed closely to prevent long-term kidney damage and promote long-term kidney health, after an illness causing AKI. We will be able to do this work, because we are a group of kidney, ICU, cardiology and general pediatric doctors who have worked together for many years to understand the negative effects of AKI on child health. We will also work together with family representatives and health care administrators to make sure that the guidelines on kidney follow-up that we recommend at the end of our study, are based on outcomes important to families and patients and are feasible within our current health care system.