Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study

Autor: Erica C. Bjornstad, William Muronya, Zachary H. Smith, Keisha Gibson, Amy K. Mottl, Anthony Charles, Stephen W. Marshall, Yvonne M. Golightly, Charles K. Munthali, Emily W. Gower
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: BMC Nephrology, Vol 21, Iss 1, Pp 1-12 (2020)
Druh dokumentu: article
ISSN: 1471-2369
DOI: 10.1186/s12882-020-01755-3
Popis: Abstract Background Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa. Methods Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI. Results We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n = 4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2–19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies. Conclusions AKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.
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