Incidence and determinants of mortality of paediatric acute kidney injury in Lagos State University Teaching Hospital, Ikeja

Abstract

Background: Acute Kidney Injury (AKI) is common and very often under-recognised especially in the developing nations. The disorder imposes a severe burden of morbidity and mortality in all regions of the world.

Aims/Objectives:  To determine the incidence of AKI, aetiological patterns and the outcome of AKI in our institution which is a major referral centre in a megacity in Nigeria. We also determined the factors that majorly contributed to mortality.

Methods: A prospective cohort study was carried out between August 2016 and September 2018. Acute kidney injury was defined using the KDIGO guideline. The severity of AKI was determined using serum creatinine or urine output criterion of the KDIGO guideline.

Result: AKI was documented in one hundred and two subjects with an incidence of 29/1000 admissions. The median age was 36.0months (IQR 3.75-84.0). Majority of the subjects 80 (78.4%) were older than 60 months and 13(12.8%) were between 0 and 12 months. Fifty-six (54.9%) were males. Majority of the AKI were community-acquired 84(82.4%). Sepsis was the leading cause of AKI (79.4%) and most of the subjects presented in KDIGO stage 3. Majority were managed conservatively 63(61.8%). Peritoneal dialysis was done on 11(10.8%), haemodialysis on 25(24.5%) and 3(2.9%) had initial PD but subsequently changed to HD. Majority of the children survived 75(74.3%), and 18(17.8%) died. Over 85% of those managed conservatively were discharged and mortality was seen only in those in KDIGO stage 3. Major determinants of outcome included level of consciousness, KDIGO stage 3, platelet level less than 100,000/mm3, acidosis and sodium level. Five (4.9%) progressed to chronic kidney disease and of this 2(1.9%) have progressed to end stage renal disease requiring transplantation.

Conclusion: Sepsis is the leading cause of AKI in our setting. Although majority of our subjects presented in the most severe form of AKI, conservative management was effective in a large proportion. Mortality was seen only in KDIGO stage 3 and the major factors associated with mortality were acidosis, thrombocytopenia, unconscious state and abnormal sodium level.