Epidemiology and outcomes of children with renal failure in the pediatric ward of a tertiary hospital in Cameroon

Abstract

BackgroundPediatric nephrology is challenging in developing countries and data on the burden of kidney disease in children is difficult to estimate due to absence of renal registries. We aimed to describe the epidemiology and outcomes of children with renal failure in Cameroon.MethodsWe retrospectively reviewed 103 medical records of children from 0 to 17 years with renal failure admitted in the Pediatric ward of the Douala General Hospital from 2004 to 2013. Renal failure referred to either acute kidney injury (AKI) or Stage 3–5 chronic kidney disease (CKD). AKI was defined and graded using either the modified RIFLE criteria or the Pediatrics RIFLE criteria, while CKD was graded using the KDIGO criteria. Outcomes of interest were need and access to dialysis and in-hospital mortality. For patients with AKI renal recovery was evaluated at 3 months.ResultsMedian age was 84 months (1QR:15–144) with 62.1% males. Frequent clinical symptoms were asthenia, anorexia, 68.8% of participants had anuria. AKI accounted for 84.5% (n = 87) and CKD for 15.5% (n = 16). Chronic glomerulonephritis (9/16) and urologic malformations (7/16) were the causes of CKD and 81.3% were at stage 5. In the AKI subgroup, 86.2% were in stage F, with acute tubular necrosis (n = 50) and pre-renal AKI (n = 31) being the most frequent mechanisms. Sepsis, severe malaria, hypovolemia and herbal concoction were the main etiologies. Eight of 14 (57%) patients with CKD, and 27 of 40 (67.5%) with AKI who required dialysis, accessed it. In-hospital mortality was 50.7% for AKI and 50% for CKD. Of the 25 patients in the AKI group with available data at 3 months, renal recovery was complete in 22, partial in one and 2 were dialysis dependent. Factors associated to mortality were young age (p = 0.001), presence of a coma (p = 0.021), use of herbal concoction (p = 0.024) and acute pulmonary edema (p = 0.011).ConclusionRenal failure is severe and carries a high mortality in hospitalized children in Cameroon. Limited access to dialysis and lack of specialized paediatric nephrology services may explain this dismal picture.

Clinical Profile and Outcome of Pediatric Acute Kidney Injury in Cameroon: Comparison between an Urban and a Semi-Urban Health Facility

“…Access to dialysis was comparable between the both groups although 30% of children in GHR could not benefit from dialysis compared to none in RHB. Reason of non-access to dialysis included lack of pediatric material [3] and financial constraints [2]. Mortality rate was high among patient who could not access to dialysis (80% # 18.2% p = 0.016).…”

“…In high income region, pediatric AKI is typical hospital-acquired, affects critical ill children and is mainly secondary to other systemic illnesses or their treatment [1]. On the other hand, in undeveloped region, such as Sub-Sahara Africa, pediatric AKI is mainly community-acquired, affected young children and due to septicemia, malaria, severe dehydration and glomerular diseases [1] [2] [3]. In sub-Saharan Africa, although dialysis access rate in children had increase, mortality remains high, about 34%, and increase to 70% if dialysis was indicated and not receive [2].…”

Outcome of acute peritoneal dialysis (APD) in renal failure among children admitted at Children’s Hospital and Institute of Child Health, Multan.

“…Timely referral as well as on time start of renal services and timely initiation of RRT as per the physician's choice can improve the outcome in such cases. [9][10] Peritoneal dialysis provides a fair renal replacement in both acute and acute on chronic renal failure; especially in children where it is easier and more compatible. It is a well know modality.…”

Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery

“…AKI presents an enormous burden to patients and the healthcare system and prevention, when possible, has been advocated by the International Society of Nephrology [2]. The reported mortality from AKI in children range from 1.2 to 50.7% [3][4][5][6], and it is associated with prolonged hospital stay and need for renal replacement therapy [3,5,6].…”