Hospital-acquired acute kidney injury in critically ill children and adolescents

This study determined the (1) hospital incidence, prevalence and etiology; (2) frequency of each of the acute kidney injury (AKI) stages and (3) the 60-day outcome. Retrospective analysis of clinico-laboratory data of Nigerian children/adolescents with hospital-acquired acute kidney injury (hAKI) was performed. AKI occurred in 103 (3.13%) of 3,286 childhood and adolescent admissions. Twenty-eight (27.2%) were hAKI while 72.8% were community-acquired AKI (cAKI). Annual hAKI incidence and prevalence rates were 0.17% (or 3.7 per million children population [pmcp]/year) and 0.84% (or 18.3 pmcp), respectively. Male (20):female (8) ratio was 2.5:1. In the hAKI group, median age was 5 (0.063-15.0) years. AKI stages 1, 2 and 3 accounted for 14.3%, 25.0% and 60.7%, respectively. AKI stage 3 was most anuric, with high dialysis requirement (P = 0.0329). Nephrotoxics (42.87%) were a leading cause of hAKI. Seventy-five percent of the recorded deaths were in the first 28 hAKI days. Median survival time was 23.5 admission (11-52) days. The means values of maximum serum creatinine (Scr) for survivors (486.0 ± 382.0 μmol/L or 5.5 ± 4.3 mg/dL) and for non-survivors (353.0 ± 160.0 μmol/L or 4.0 ± 1.8 mg/dL) were similar (P > 0.20). The 60-day cumulative mortality was 36.7%. Scr severity may not be a reliable mortality determinant among AKI patients. The maximal mortality in the first 28 days of hAKI onset and overall high mortality rate indicate that high level of clinical vigilance and informed therapeutic intervention will be critical to survival during this period. Cause of death was multi-factorial.