Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study

Abstract

BackgroundIn low and middle-income countries, reliable data on the epidemiology of childhood acute kidney injury (AKI) is lacking. The Global Snapshot, conducted by the ISN “0by25” AKI initiative, was a world-wide cross-sectional, observational study to evaluate AKI in hospitalized patients. Here we report the pediatric results of this study.Patients and methodsWe prospectively collected data on children who met the Kidney Disease Improving Global Outcomes AKI criteria during a 10-week window in late 2014. AKI risk factors, etiological factors, management and outcomes were recorded using standardized forms and protocols. Countries were classified according to their 2014 gross national income (GNI) per person into high-income countries (HIC), upper-middle income countries (UMIC) and low and low-middle income countries (LLMIC). Need for renal replacement therapy, mortality, and renal recovery were assessed 7 days after AKI diagnosis or at hospital discharge, whichever came first.Results92 centers from 41 countries collected data on 354 pediatric AKI patients; 53% of the children developed AKI while hospitalized and 47% in the community. The most common etiological factors for AKI differed across GNI categories as well as between patients with community-acquired vs. hospital-acquired AKI. Children from HIC were younger, and larger proportion of AKI in this group were due to post-surgical complications vs. other etiologies when compared to other income categories. In patients with hypotension as the cause of AKI, the adjusted risk of death was almost 10-fold higher compared to patients without hypotension as an etiological factor for AKI development. Mortality was similar within AKI stages in HIC and UMIC. In LLMIC, patients with the highest AKI level of severity had higher mortality than patients in higher income categories. Patients from LLMIC and UMIC had a 57-fold and 11 fold higher adjusted risk of death, respectively, compared to patients from HIC.ConclusionIn resource-limited countries, pediatric AKI-associated mortality is disproportionately higher when compared to high-resource areas, especially among patients with more severe AKI.

International Society of Nephrology 0 by 25 Project: Lessons Learned

“…In pediatric patients, the mortality rate was significantly different (19.6%) in LMIC compared to 1.2% in HIC [9]. Mortality in community-acquired AKI was higher in LMIC (11%) vs. 9% in HIC.…”

“…The worldwide application of the RIFLE/AKIN (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease/Acute Kidney Injury Network) and KDI-GO (Kidney Disease: Improving Global Outcomes) classification systems has confirmed the increasing incidence of AKI in different settings [5][6][7][8][9]. The efforts of nephrology and critical care societies to create a unified classification system have enabled comparisons of AKI incidence and outcomes across diverse populations.…”

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].…”

“…The patterns and prevalences of AKI differ between developing countries that are largely in the low-to middle-income categories and the developed ones in high-income group. As much as 73 to 80% of AKI occur in the community in low-and middle-income countries (LMICs), compared to 20% in high-income countries (HICs) [4,6,7]. A perioperative risk factor was identified in 4% to 6% of children with AKI in LMICs and in as much as 27% in HICs [4].…”

“…As much as 73 to 80% of AKI occur in the community in low-and middle-income countries (LMICs), compared to 20% in high-income countries (HICs) [4,6,7]. A perioperative risk factor was identified in 4% to 6% of children with AKI in LMICs and in as much as 27% in HICs [4]. The risk factors for community-acquired AKI in children are largely related to public health infrastructural challenges such as sanitation, infectious diseases, and diarrhoeal diseases [4], but this cannot be said of perioperative AKI, where the variables surrounding the development of AKI are largely related to the characteristics and severity of the disease and its management in respective healthcare settings.…”