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

Abstract

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.

Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort

“…We previously showed that the baseline creatinine definition for children has a strong impact on detected AKI incidence and that for this African setting, the new Schwartz equation may be optimal. 13 We conducted a prospective study because retrospective and case-control studies are difficult in low-resource areas in which creatinine values are not routinely obtained. However, only 36 participants developed AKI, and only 12 developed severe AKI (stage 2 or 3), thereby limiting our inferences.…”

“…This validation study of diagnostic accuracy was nested within a prospective cohort study to evaluate the incidence of AKI among admitted trauma patients. 13 The study was conducted at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi.…”

“…The overall study screened 4547 patients (674 eligible) and enrolled 337 participants. 13 For this nested validation study, an additional requirement for inclusion was the ability to provide a fresh urine sample on admission.…”

“…18 We subsequently back-calculated a baseline creatinine using the new (bedside) Schwartz equation based on our previous work in Malawian children. 13,19 As mentioned above, routine laboratory testing is quite unreliable at KCH's main public laboratory. To ensure reliable and consistent laboratory results, all laboratory testing was conducted at the University of North Carolina (UNC) Project Malawi Laboratory, which is a state-of-the-art research laboratory on-site at KCH.…”

Reno-protective effect of exogenous glutathione on experimentally-induced acute kidney injury in male rats.

“…The incidence of AKI increased both in hospital and community settings. It is estimated that the incidence of AKI could be from 2 to 3 cases per 1000 population [2]. It was reported that around 7% of hospitalized patients and about 66% of patients in intensive care units could develop AKI.…”