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Variables associated with CKD were analysed for their potential effect on annualised eGFR change (\u0394GFR\/year) following multiple regression analysis. Composite end-point including 25% reduction in eGFR or progression to kidney replacement therapy was evaluated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 147 children, 116 had at least 1-year follow-up in a\u00a0dedicated CKD clinic with mean age 7.3 \u00b1 4.9 years with 91 (78.4%) and 77 (66.4%) with 2- and 3-year follow-up respectively. Mean eGFR at baseline was 29.8 \u00b1 11.9 ml\/min\/1.73 m<jats:sup>2<\/jats:sup> with 79 (68%) boys and 82 (71%) with congenital abnormalities of kidneys and urinary tract (CAKUT). Thirty-nine (33.6%) had at least one episode of AKI. Mean \u0394GFR\/year for all patients was \u2212 1.08 \u00b1 5.64 ml\/min\/1.73 m<jats:sup>2<\/jats:sup> but reduced significantly from 2.03 \u00b1 5.82 to \u2212 3.99 \u00b1 5.78 ml\/min\/1.73 m<jats:sup>2<\/jats:sup> from youngest to oldest age tertiles (<jats:italic>P<\/jats:italic> &lt; 0.001). There was a significant difference in primary kidney disease (PKD) (77% versus 59%, with CAKUT, <jats:italic>P<\/jats:italic> = 0.048) but no difference in AKI incidence (37% versus 31%, <jats:italic>P<\/jats:italic> = 0.85) between age tertiles. Multiple regression analysis identified age (<jats:italic>\u03b2<\/jats:italic> = \u2212 0.53, <jats:italic>P<\/jats:italic> &lt; 0.001) and AKI (<jats:italic>\u03b2<\/jats:italic> = \u2212 3.2, <jats:italic>P<\/jats:italic> = 0.001) as independent predictors of \u0394GFR\/year. 48.7% versus 22.1% with and without AKI reached composite end-point (<jats:italic>P<\/jats:italic> = 0.01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We report AKI in established CKD as a predictor of accelerated kidney disease progression and highlight this as an additional modifiable risk factor to reduce progression of kidney dysfunction.<\/jats:p>\n                <jats:p>Graphical abstract<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00467-020-04777-z","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T10:04:00Z","timestamp":1603793040000},"page":"1279-1288","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Acute kidney injury in children with chronic kidney disease is associated with faster decline in kidney function"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0660-0683","authenticated-orcid":false,"given":"Nabil","family":"Melhem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pernille","family":"Rasmussen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Triona","family":"Joyce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Clothier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J. 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