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

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.

Epidemiology of Cardiopulmonary Arrest and Outcome of Resuscitation in PICU Across China: A Prospective Multicenter Cohort Study

“…Respiratory, circulatory, hematologic, or oncologic status and infection are common causes for critical diseases ( 13 ) and CPA ( 1 , 3 , 11 ) in PICU, because they could induce severe hypoxemia, hypovolemia, acid-base disturbance, and multiple organ disease syndrome. Similar to previous studies ( 1 , 3 , 9 , 14 ), our results showed that respiratory and circulatory diseases were the major contributors to CPA. Trauma was rarely mentioned in previous reports on the characteristics of CPA.…”

“…Our results showed that the ROSC of trauma was 50%, but only 16.7% had survived to discharge. We made no further analysis about the exact cause of death in trauma, but trauma-associated respiratory ( 16 ) and renal injury ( 14 ) were attributed to increased mortality.…”

High risk of acute kidney injury in Malawian trauma patients: a prospective observational cohort study

“…This finding is similar to other studies in South Africa and high-income settings [8,[31][32][33]. This increased risk of mortality was also seen in our previous analysis of pediatric trauma patients [15]. As Malawi has one of the highest rates of road traffic injuries in the world [34,35], confirming that trauma leads to high AKI rates in lowincome settings is important as this may be an intervenable target to improve trauma-related mortality.…”

“…For our prospective study, we included all admitted patients with an expected admission > 24 h, and this analysis focuses on the adult patients (> 18 years of age). The pediatric analysis has already been published [15]. Informed consent was obtained from all patients, or if they had altered mental status, a guardian needed to be present and informed consent obtained within 18 h of patient arrival.…”

Lipid-Based Nanocarriers in Renal RNA Therapy

“…The global prevalence of chronic kidney disease (CKD) is estimated at approximately 13.4%, while estimates suggest that acute kidney injury (AKI) affects approximately 13.3 million people globally every year [ 1 , 2 ]. According to the Global Burden of Disease study in 2017, 1.2 million deaths were attributed to CKD, and it was the 12th leading cause of death worldwide [ 3 ].…”