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Acute kidney injury in paediatric patients with sickle cell disease is associated with increased morbidity and
Meghan McCormick1, Troy Richardson2, Bradley A Warady3
1UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Insights
Acute kidney injury (AKI) affects 1.4% of pediatric sickle cell disease (SCD) patients, increasing hospital resource use. Hydroxycarbamide may reduce AKI risk in these vulnerable children.
Area of Science:
- Pediatric Nephrology
- Hematology
- Clinical Epidemiology
Background:
- Sickle cell disease (SCD) frequently leads to renal complications.
- The epidemiology and long-term impact of acute kidney injury (AKI) in pediatric SCD patients remain poorly understood.
Purpose of the Study:
- To investigate the incidence and risk factors of AKI in hospitalized pediatric patients with SCD.
- To assess the association of AKI with hospital outcomes and long-term renal morbidity.
Main Methods:
- Retrospective analysis of inpatient encounters for pediatric SCD patients using the Pediatric Health Information System (PHIS).
- Identification of AKI episodes during admissions for vaso-occlusive pain crisis (VOC).
- Generalized estimating equation modeling to identify risk factors and protective agents for AKI.
Main Results:
- AKI occurred in 1.4% of pediatric SCD patients and complicated 2.5% of admissions.
- Patients with AKI had higher rates of ICU admission, longer hospital stays, increased costs, and higher readmission risk.
- Increasing age, hypertension, hematuria, and chronic kidney disease were associated with increased AKI odds, while hydroxycarbamide use was protective (OR 0.64).
Conclusions:
- Hospitalizations for AKI in pediatric SCD patients are linked to significant morbidity and increased healthcare utilization.
- Hydroxycarbamide therapy may be a valuable strategy to mitigate AKI risk in this population.
Abstract:
Renal disease is a common complication experienced by patients with sickle cell disease (SCD), though the epidemiology of acute kidney injury (AKI) in paediatric patients and its impact on long-term renal outcomes is unclear. We utilized the Pediatric Health Information System (PHIS) to identify inpatient encounters of paediatric patients with SCD admitted for vaso-occlusive pain crisis (VOC). Overall, 1·4% of patients experienced at least one episode of AKI and 2·5% of admissions were complicated by AKI. Patients with at least one episode of AKI were more likely to be adolescents or young adults at the time of their initial admission, had increased rates of admission to the ICU, longer lengths of stay, increased costs of hospitalization, increased risk of readmission and increased rates of SCD-related comorbidities. Generalized estimating equation modelling demonstrated that increasing age, history of hypertension, history of haematuria and history of chronic kidney disease were associated with increased odds of developing AKI, though hydroxycarbamide use (OR 0·64, 95% CI 0·44-0·94) was protective. Episodes of AKI during hospitalization in children with SCD are associated with increased morbidity and utilization of hospital resources. Increasing the use of hydroxycarbamide may decrease the likelihood of this complication.
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