Epidemiology and outcome of pediatric acute kidney injury-multicenter observational study from a low-middle-income country.

Abstract

Background: The epidemiology and outcome of acute kidney injury (AKI) in low-middle-income countries (LMICs) differ from those in high-income countries due to differences in type and severity of non-renal systemic illness and variability in nephrology-care facilities. There is a paucity of multicenter studies from LMICs. This multicenter observational study was undertaken to study the epidemiology of pediatric AKI in a LMIC and analyze the significance of associated sample characteristics and interventions on outcomes, namely renal recovery and mortality.

Methods: Children (1 month-18 years) diagnosed with AKI, based on KDIGO criteria, seen in 10 centers, over 30 months, were included. Data collected included hospital type, city, patient demographics, illness characteristics, pre-existing diseases, AKI profile, interventions including mechanical ventilation (MV), vasoactive drugs (VADs), nephrotoxic drugs, radiocontrast exposure, and recent surgery. Use of kidney replacement therapy (KRT), modality, renal recovery, and patient survival was assessed.

Results: Non-renal systemic illness accounted for 79% of cases. Majority were infections. Pre-existing illness was present in 55%, with 29% having kidney disease. AKI was diagnosed at admission in 68%, with 40% in KDIGO stage 3; 50% had severe AKI. MV and VADs were used in 42% and 46%, respectively. KRT was required in 29%, most receiving acute peritoneal dialysis (58%). Complete recovery (CR) was seen in 44%, while 29.6% died. Pre-existing kidney disease and KRT negatively impacted CR. VAD use was linked to mortality, and CR was associated with survival.

Conclusions: Non-renal systemic infection was the leading cause of AKI characterized by early, rapid progression, severe in 50%, high need for KRT, CR in less than 50% and high mortality.