Prevalence of acute kidney injury in critically ill children at Kenyatta National Hospital

Abstract

Background: In developing countries AKI is often a community acquired disease affecting the young and children with a high mortality. Preventable prerenal mechanisms predominate. Studies done under the newly proposed unified criteria for definition of AKI have documented that its incidence is highest in critically ill patients and is an independent risk factor for mortality. At KNH, the mortality in our paediatric wards is highest in the first 72 hrs of admission. Renal function monitoring is often overlooked and the magnitude of AKI remains unknown. Study objective: The main objective of this study was to determine the prevalence of AKI in critically ill children triaged and admitted at KNH pediatric wards and ICU. Secondary objectives were to determine the demographic characteristics of the study subjects with AKI, its clinical correlates such as diagnosis and herbal medication use, and to compare outcome of the study subjects with and without AKI. Methodology: During the study period, critically ill patients were identified as children aged 1 month- 12 years presenting with any emergency sign at PEU/ICU and those who changed condition to be critically ill by any of the WHO emergency signs at any time during their admission. The principle investigator identified these patients, obtained consent, did clinical evaluation relevant to the questionnaire and proceeded to obtain blood sample for serum creatinine analysis. Patients were then stratified for AKI by the pRIFLECr criteria. Those patients who remained critically ill 24 hours after initial Cr analysis had a repeat analysis and re-stratification for AKI. Outcome (discharged/ still in ward/died) for the study subjects was determined at day 5 post recruitment into the study. Results: Out of the 117 children enrolled in the study, 100 met the pRIFLEcr criteria for AKI. This gave a prevalence rate of 85.5%. Female gender, younger age and a diagnosis of GE were associated with increased prevalence of AKI(p values 0.023, 0.000 and 0.002 respectively). There was no statistically significant association between AKI and mortality comparing those with and without AKI. Mortality for patients with AKI increased with increasing pRIFLEcr stratum. Conclusion: Renal function monitoring should be part of the baseline tests in all our citically ill children for detection of AKI at its mildest stage. A large hospital based prospective study is needed