Acute kidney injury in children with acute febrile tropical illness.

Abstract

Background: We aimed to determine the incidence, predictors, and outcomes of acute kidney injury (AKI) in children hospitalized with acute febrile tropical illnesses (AFTI).

Methods: This prospective observational study was conducted at a tertiary-care centre in north India over 1.5 years. Consecutive children (2 months-18 years) admitted with AFTI were enrolled. AKI was defined using KDIGO criteria based on serum creatinine and urine output. The primary outcome was the incidence of AKI in children with AFTI. Secondary outcomes included predictors for AKI, need for organ support, and mortality. Least absolute shrinkage and selection operator (LASSO) regression followed by multivariable logistic regression with bootstrap internal validation was used to identify independent predictors of AKI.

Results: Amongst 585 enrolled children with AFTI, AKI occurred in 68 (11.6%), of whom 30 (44.2%) had severe AKI (KDIGO stage 2/3). With respect to etiology, AKI was significantly more frequent in dengue with warning signs, malaria, leptospirosis and brucellosis. Children with AKI had significantly higher requirements for intensive care interventions, including intubation, inotropes, kidney replacement therapy, and longer duration of hospitalization. Mortality was markedly higher in the AKI group (19.1% vs. 0.19%, p < 0.001). On multivariable logistic regression, age (months), inotropic support and use of ≥ 2 nephrotoxic medications in 24 h period were independently associated with development of AKI.

Conclusions: AKI affects one in ten children hospitalized with AFTI and is strongly associated with disease severity, organ support, and mortality. Age, inotropic support and use of ≥ 2 nephrotoxic medications were independent predictors of AKI in children with AFTI.