916 Prevalence, risk factors and outcome of acute kidney injury in hopsitalised children at the JOS university teaching hospital JOS, Plateau state. Nigeria

Abstract

<h3>Background</h3> Acute Kidney Injury (AKI) is a disease of global importance, contributing to high childhood morbidity and mortality. It is a preventable and treatable disease. Early identification of risk factors can prevent disease initiation and enhance prompt diagnosis and treatment. There are limited data regarding the risk factors and outcome on the disease in Nigeria especially in Jos, Plateau state, and its neighbouring states. <h3>Objectives</h3> The objectives of the study was as follows (1) to determine the prevalence of AKI in hospitalised children at the Jos University Teaching Hospital (JUTH). (2) To determine the risK factors among hospitalised children with AKI at JUTH. (3) To determine the outcome of AKI in hospitalised children at JUTH (4) To determine the association of the risk factors with the outcome of acute kidney injury in hospitalised children at JUTH <h3>Methods</h3> This was a longitudinal hospital based study of 338 children aged 1 month to 18 years admitted to the Jos University Teaching Hospital, Plateau stated via the Emergency Paediatric Unit (EPU), from August to November 2018. All children were screened for AKI using the ‘Paediatric Risk, Injury, Failure, Loss, End stage renal disease’ (pRIFLE) diagnosis criteria after obtaining the estimated Creatinine Clearance (eCCl) and urine output. The participants were assessed daily on admission until discharge or death. Normative values for eCCl reference were used for all children. Data were stored on Microsoft excel spreadsheet then transported to Statistical Package for Social Sciences (SPSS) for analysis. Mean and frequencies were computed and association of risk factors for AKI occurrence and output were calculated using chi-square and odds ratio. Significant risk factors were further subjected multiple logistic regressions. P-value of less than 0.5 was significant. <h3>Results</h3> The prevalence of AKI from the study was 21.30%. The study diagnosed more participants (50%) in the least severe ‘R’ stage. Independent risk factors for the development of AKI identified include, sepsis, (p-value &lt;0.001, OR 5.56,CI 2.57–12.05), primary kidney disease (Nephotic syndrome and Acute Glomerulonephritis) (p-value &lt;0.001, OR 15.04, CI 5.37–42.13), heart failure (p-value &lt;0.001, OR 8.14, CI 3.38–19.59), and chronic kidney disease (p-value 0.021,OR 14.38, CI 1.49–138.69). The mortality rate from AKI was 20.83%. Among discharges, 82.46% of the discharged recovered fully from AKI while 17.54% had residual kidney injury. Sepsis (p-value &lt;0.001, OR 8.36, CI 2.38–29.46) and severe stage of AKI (p-value &lt;0.001, OR 14.93, CI 3.64–76.92) were the most important risk factors for poor outcome in children with AKI. <h3>Conclusions</h3> From this study therefore it can be said that AKI is a disease that is commonly associated with hospital admission (21.3%), though it is preventable and treatable when recognised early due to the high recovery rate with earlier stages of the disease. More worrisome is the high mortality rate 20.83% which contributed to 78.95% of total hospital mortality in the admitted children. Screening for risk factors early at the point of admission will prevent development of the disease and progression to severe stage.