Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi

Evans, Rhys; Hemmilä, Ulla; Craik, Alison; Mtekateka, Mwayi; Hamilton, Fergus; Kawale, Zuze; Kirwan, Christopher; Dobbie, Hamish; Dreyer, Gavin

doi:10.1186/s12882-017-0446-4

Cited by 60 publications

(75 citation statements)

References 18 publications

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“…This target sample size would allow us to detect a 17% incidence with precision of +/− 5%, assuming a 10% loss-to-follow-up rate for patients leaving against medical advice prior to the second creatinine value. There were no published estimates of pediatric AKI in Malawi at the time of study planning, so our estimates come from an adult study in Blantyre, Malawi of general medical admissions [26].…”

Section: Sample Sizementioning

confidence: 99%

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

et al. 2020

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Background: 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. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.Methods: Prospective 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. Results: We 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. Conclusions: AKI 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.

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Section: Sample Sizementioning

confidence: 99%

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

et al. 2020

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“…There were no published estimates of pediatric AKI in Malawi at the time of study planning, so our estimates come from an adult study in Blantyre, Malawi of general medical admissions. [26] Analysis: For our secondary outcome, we used descriptive analyses to assess the three different equation methods for estimating a child's baseline creatinine compared to our a priori "gold standard" of the lowest creatinine method. The optimal equation method was then used to determine the incidence of AKI (our primary outcome of interest) in our study population.…”

Section: Outcomementioning

confidence: 99%

Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

Bjornstad

Muronya

Smith

et al. 2020

Preprint

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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. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa. Methods Prospective 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. Results We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4-10%. 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. Conclusions AKI 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.

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“… 3 In Malawi, a low-income country in southeast Africa, 21% of general medical admissions have kidney injury at presentation and in-hospital mortality is 44% in those with AKI, despite free access to tertiary nephrology services including renal replacement therapy. 4 …”

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confidence: 99%

A Salivary Urea Nitrogen Dipstick to Detect Obstetric-Related Acute Kidney Disease in Malawi

Evans

Cooke

Hemmilä

et al. 2018

Kidney International Reports

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IntroductionObstetric-related acute kidney injury (AKI) is associated with adverse outcomes for mother and fetus, particularly in low-income countries. However, laboratory-independent tools to facilitate diagnosis are lacking. We assessed the diagnostic performance of a salivary urea nitrogen (SUN) dipstick to detect obstetric-related acute kidney disease in Malawi.MethodsWomen at high risk for AKI admitted to an obstetric unit in Blantyre, Malawi, were recruited between 21 September and 11 December 2015. Patients underwent serum creatinine (SCr) testing alongside measurement of SUN using a dipstick on admission, and every 48 hours thereafter if evidence of kidney disease was found.ResultsA total of 301 patients were included (mean age 25.9 years, 11% HIV positive). Of the patients, 23 (7.6%) had AKI, stage 1 in 47.8%, most commonly due to preeclampsia/eclampsia. Mean presenting SCr values were 108.8 ± 21.8 μmol/l (1.23 ± 0.25 mg/dl), 118 ± 34.45 μmol/l (1.33 ± 0.39 mg/dl), and 136.1 ± 30.4 μmol/l (1.54 ± 0.34 mg/dl) in AKI stages 1 to 3 respectively. SUN > 14 mg/dl had a sensitivity of 12.82% and a specificity of 97.33% to detect acute kidney disease; the area under the receiver operating characteristic curve was 0.551. In patients with normal SUN on admission, perinatal mortality was 11.8%, and was 25.0% if SUN was > 14 mg/dl (P = 0.18).ConclusionThe SUN dipstick was specific but insensitive when used to diagnose obstetric-related AKI. Limited biochemical derangement and low salivary urea concentrations due to physiological changes in pregnancy, as opposed to a technical limitation of the dipstick itself, are the likely reason for the lack of sensitivity in this study.

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Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi

Cited by 60 publications

References 18 publications

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

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

Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

A Salivary Urea Nitrogen Dipstick to Detect Obstetric-Related Acute Kidney Disease in Malawi

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