Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study

Erica C Bjornstad,Anthony Charles,Stephen W Marshall,Keisha Gibson,Amy K Mottl,Zachary H Smith,William Muronya,Charles K Munthali,Yvonne M Golightly,Emily W Gower

doi:10.1186/s12882-020-01755-3

Abstract

BackgroundAcute 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.MethodsProspective 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.ResultsWe analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 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.ConclusionsAKI 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.

Highlights

Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide
Since that meta-analysis, more studies from Africa have emerged on pediatric AKI and they have focused on infection-related AKI (e.g., AKI in those with malaria) or non-surgical-related AKI [4,5,6]
A total of 4547 adult and pediatric trauma patients presenting to Kamuzu Central Hospital (KCH) were screened, and 674 (14.8%) were eligible for enrollment (Fig. 1)

Summary

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. There is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa. Estimates suggest that 13.3 million people worldwide are affected by acute kidney injury (AKI) annually, 85% of whom live in developing countries [1, 2]. Since that meta-analysis, more studies from Africa have emerged on pediatric AKI and they have focused on infection-related AKI (e.g., AKI in those with malaria) or non-surgical-related AKI [4,5,6]. There has been a paucity of investigation into AKI associated with trauma in Africa, despite the high burden of trauma in children

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