Determinants of modality of management of acute kidney injury in children seen at a tertiary hospital in Nigeria

Abstract

Background: The cost of taking care of children with acute kidney injury (AKI) is enormous and beyond the reach of many caregivers in  sub-Saharan Africa which are largely resource poor. It is therefore imperative to determine those who may benefit from conservative management which is comparatively cheaper to the renal replacement therapy (RRT).
Objectives: To determine the clinical characteristics of children who were offered conservative and renal replacement therapy and evolve the most statistically significant eligibility criteria. Methods: A descriptive  crosssectional study of children presenting with AKI admitted into the Emergency Paediatric Unit (EPU) of the University of Ilorin Teaching Hospital (UITH) between January 2008 to December 2012 was carried out. Demographic, clinical, and laboratory data were collected. A serial
blood chemistry and urine analysis were also obtained. A total of 22 cases of acute kidney injury were seen within the period. Fourteen were conservatively managed while eight underwent sessions of dialysis.
Results: The age range for those who had conservative management
was 4-17 years with a mean ±SD of 8.11±3.91 years while the corresponding value in those with renal replacement therapy was 1.5-16
years with a mean ±SD of 9.68±5.54years. There was no statistical
significant difference in the highest serum potassium, urea and
creatinine. However, the lowest urine output was significantly different
among the two groups (p< 0.05).
Conclusion: Urine output could be used as an eligibility criterion to
determine children with AKI who will require renal replacement therapy or benefit from a trial of conservative management.

Keyword: Acute kidney injury; conservative management; dialysis