Improved outcomes of renal injury following burn trauma

Demsey, Daniel; Mordhorst, Alexa; Griesdale, Donald; Papp, Anthony

doi:10.1016/j.burns.2019.04.001

Cited by 11 publications

(12 citation statements)

References 27 publications

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“…Several studies have identified high rates of AKI in adult burn patients. [35]- [37], [42], [43] The retrospective study on pediatric burn patients also found a high incidence of AKI and that development of sepsis was an independent risk factor for AKI. [41] We did not evaluate for sepsis in our study due to the additional associated costs.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

Bjornstad

Muronya

Smith

et al. 2020

Preprint

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Introduction 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 4-10%. 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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Section: Discussionmentioning

confidence: 99%

Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

Bjornstad

Muronya

Smith

et al. 2020

Preprint

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“…AKI is a well-known risk factor for mortality in children with sepsis, malaria, and critical illness [4-6, 16, 33, 34]. AKI in adult trauma patients is also known to increase the risk of death [35][36][37][38][39], but little is known about AKI in pediatric trauma patients. To our knowledge, this is only the third study to show that AKI in children with trauma significantly increased the risk of death compared to those without AKI (40% vs 6.5%, RR 6.5 with 95% CI 2.2-19.1).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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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“…Risk of bias is summarized in Supplementary Table 1 of the (cohort or case-control studies) and Supplementary Figure 1 of the (RCT studies). Among the 57 included studies, 22 were from North America ( 4 , 9 , 15 , 16 , 24 , 26 , 28 , 30 , 31 , 33 , 34 , 40 , 42 – 44 , 48 – 50 , 54 , 59 , 61 , 62 ), 18 were from Asia ( 5 , 7 , 19 , 21 – 23 , 25 , 36 – 38 , 41 , 46 , 47 , 51 , 52 , 58 , 64 , 67 ), 15 were from European countries ( 6 , 17 , 18 , 20 , 27 , 32 , 35 , 45 , 53 , 55 – 57 , 60 , 65 , 66 ), one was from South America ( 29 ), one was Africa ( 39 ). A total of 12 studies could not be used for analysis of the prevalence of RRT, seven of which only reported on RRT patients ( 9 , 18 , 34 , 37 , 38 , 43 , 45 ), four of which were RCT studies ( 40 , 41 , 51 ,…”

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of Renal Replacement Therapy for Burn Patients: Incidence Rate, Mortality, and Renal Outcome

Duan

Cai

et al. 2021

Front. Med.

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Background: Renal replacement therapy (RRT) was often needed by some severe burn patients with acute kidney injury (AKI). The primary aim of this study was to review incidence rate and mortality of RRT in severe burn patients. Second aims were to review RRT complications and renal outcome.Methods: We searched multiple databases for studies published between 1 January 1960 and 31 December 2019. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included.Results: A total of selected 57 studies, including 27,437 patients were enrolled in our analysis. The prevalence rates of RRT were 8.34% (95% CI 7.18–9.5%) in all burn patients and 37.05% (95% CI 29.85–44.24%) in AKI patients. The mortality of all burn patients with RRT was 65.52% (95% CI 58.41–72.64%). The prevalence rates of RRT in sample size≥100 group were 6.86% (95% CI 5.70–8.03%), which was lower than that of <100 group (17.61%, 95% CI 13.39–21.82%). With the increase of TBSA, the prevalence of RRT may have the increasing trend. The prevalence rates of RRT in Asian group was 12.75% (95% CI 9.50–16.00%), which was higher than that of European (10.45%, 95% CI 7.30–13.61%) and North America group (5.61%, 95% CI 4.27–6.95%). The prevalence rates of RRT in 2010–2019 group was 12.22% (95% CI 10.09–14.35%), which was higher than that of 2009–2000 group (5.17%, 95% CI 2.88–7.46%). The prevalence rates of RRT in 1989 and before group was the lowest, which was 1.56% (95% CI 0–3.68%). However, there was no significant correlation between the year of publication and the mortality of burn patients with RRT. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain haemodialysis temporarily, even if they survive and leave hospital.Conclusions: The prevalence rate of RRT is about 6–8%; approximately, one-third of burn patients with AKI need RRT. The prevalence rate of RRT increased over time, but the mortality did not change. The prevalence rates of RRT in Asian group was higher than that of European and North America group.

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Improved outcomes of renal injury following burn trauma

Cited by 11 publications

References 27 publications

Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

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

Meta-Analysis of Renal Replacement Therapy for Burn Patients: Incidence Rate, Mortality, and Renal Outcome

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