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The Epidemiology and Management of Pediatric AKI in Asia
Ruochen Che1, Mohammed Mazheruddin Quadri1, Aihua Zhang1
1Department of Nephrology, State Key Laboratory of Reproductive Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China.
Insights
Pediatric acute kidney injury (AKI) in Asia is underestimated due to delayed recognition and referral. Addressing this requires improved diagnostics, accessible treatments like peritoneal dialysis, and urgent education for healthcare providers and families.
Area of Science:
- Pediatric Nephrology
- Global Health
- Critical Care Medicine
Background:
- Pediatric acute kidney injury (AKI) incidence in Asia is underestimated, often due to delayed recognition and referral.
- The Kidney Disease Improving Global Outcomes (KDIGO) classification is the widely accepted standard for diagnosing AKI.
- Pediatric AKI in Asia presents a broad spectrum, from hospital-acquired conditions in developed areas to preventable causes in rural regions.
Purpose of the Study:
- To highlight the underestimation of pediatric AKI in Asia.
- To discuss the challenges and advancements in pediatric AKI diagnosis and management across diverse Asian healthcare settings.
- To emphasize the need for accessible and cost-effective interventions and education.
Main Methods:
- Review of current diagnostic criteria, focusing on the KDIGO classification.
- Analysis of the diverse etiologies and clinical presentations of pediatric AKI in Asia.
- Evaluation of novel biomarkers, the Renal Angina Index, and renal replacement therapies in the Asian context.
- Consideration of peritoneal dialysis as a feasible option for resource-limited settings.
Main Results:
- The spectrum of pediatric AKI in Asia ranges from complex cases in tertiary centers to preventable causes in primary care settings.
- While novel diagnostic and therapeutic advancements exist, cost and feasibility remain significant barriers, particularly in rural areas.
- Peritoneal dialysis is recommended as a primary treatment option for less-developed regions, but implementation faces various challenges.
Conclusions:
- Effective management of pediatric AKI in Asia requires addressing underestimation through early recognition and referral.
- Cost-effective and accessible treatment modalities, such as peritoneal dialysis, need further development and implementation.
- Urgent educational initiatives targeting healthcare providers and families are crucial for improving outcomes in pediatric AKI across Asia.
Abstract:
Because of the lack of early recognition and referral, the incidence of pediatric acute kidney injury (AKI) in Asia still is underestimated. Although each diagnostic criteria has its own merits, the Kidney Disease Improving Global Outcomes classification now is widely accepted. In Asia, the spectrum of pediatric AKI is wide-ranging, from pediatric AKI in highly sophisticated tertiary-care pediatric intensive care units in resource-rich regions due to advanced procedures such as transplantation, cardiac surgery, and other hospital-acquired causes, to primary care preventable causes, such as infectious diseases, snakebite, and so forth in rural parts of the developing world. The development and application of novel biomarkers, concepts such as the Renal Angina Index and advanced renal replacement therapy have revolutionized the era of treating AKI, but the cost and feasibility are the key determinants, especially in rural areas. In view of availability and expenses, peritoneal dialysis should be the first choice in less-developed areas, however, because of various barriers, it still needs more effort. Effective educational steps to both medical carers and families are needed urgently.
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