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Acute kidney injury in hospitalized children with sickle cell anemia

Anthony Batte1, Sahit Menon2, John Ssenkusu3

  • 1Child Health and Development Centre, Makerere University College of Health Sciences, P.O Box 6717, Kampala, Uganda. abatte2002@yahoo.com.

BMC Nephrology
|March 19, 2022
PubMed

Insights

Acute kidney injury (AKI) is common in children with sickle cell anemia (SCA) during vaso-occlusive crisis (VOC). A modified KDIGO definition better predicts outcomes, highlighting the need for early AKI detection and treatment in pediatric SCA patients.

Area of Science:

  • Pediatric Nephrology
  • Hematology
  • Critical Care Medicine

Background:

  • Children with sickle cell anemia (SCA) face a heightened risk of acute kidney injury (AKI), potentially leading to severe complications or chronic kidney disease.
  • This study investigates the prevalence and risk factors of AKI in pediatric SCA patients experiencing a vaso-occlusive crisis (VOC) within a low-resource healthcare setting.

Purpose of the Study:

  • To evaluate the prevalence of AKI in children with SCA hospitalized for VOC.
  • To identify risk factors associated with AKI in this vulnerable pediatric population.
  • To assess the impact of modifying the Kidney Disease: Improving Global Outcomes (KDIGO) definition on AKI clinical outcomes in pediatric SCA patients with VOC.

Main Methods:

  • A prospective study enrolled 185 children (2-18 years) with SCA (Hemoglobin SS) hospitalized with VOC in Uganda.
  • Kidney function was monitored using enzymatic creatinine measurements, with AKI defined by the original KDIGO criteria and a modified SCA-KDIGO (sKDIGO) definition.
  • The sKDIGO definition excluded cases where the creatinine increase was solely due to a 1.5-fold change from 0.2 mg/dL to 0.3 mg/dL.

Main Results:

  • The original KDIGO definition identified AKI in 48.7% of patients (33.0% on admission, 23.4% incident), while the sKDIGO definition identified AKI in 36.2% (23.2% on admission, 16.9% incident).
  • The sKDIGO definition, unlike the original KDIGO, was significantly associated with increased mortality (7.5% vs. 0.9%, p=0.024).
  • Identified AKI risk factors included older age, hypovolemia, tender hepatomegaly, and infection (all p<0.05).

Conclusions:

  • AKI is a frequent complication in children with SCA during VOC, underscoring the need for vigilant monitoring.
  • The modified sKDIGO definition demonstrated superior predictive value for clinical outcomes, including mortality, in pediatric SCA patients.
  • Targeted interventions for early AKI identification and management are crucial for improving clinical outcomes in children with SCA.
Abstract

Keywords:
Acute kidney injuryChildrenCystatin CHemoglobinuriaInfectionMalariaSerum creatinineSickle cell anemiaSub-Saharan AfricaVaso-occlusive crises

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