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Risk factors associated with acute kidney injury in a pediatric intensive care unit in Addis Ababa Ethiopia:
Mulualem Keneni1, Rajalakshmi Murugan2, Ketema Bizuwork2
1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Insights
Sepsis, hypertension, shock, nephrotoxic drugs, and mechanical ventilation are key risk factors for acute kidney injury (AKI) in critically ill children. Early identification and intervention are crucial for preventing AKI in this vulnerable population.
Area of Science:
- Pediatric Intensive Care
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a significant concern in critically ill children, leading to adverse outcomes and high mortality.
- Globally, AKI affects one in three critically ill children, but data from Ethiopia remain limited.
- Understanding AKI risk factors in Ethiopian pediatric intensive care units (PICUs) is essential for improving patient care.
Purpose of the Study:
- To identify risk factors associated with acute kidney injury (AKI) in critically ill children.
- To provide data specific to the Ethiopian context, particularly Addis Ababa.
- To inform targeted prevention and management strategies for AKI in pediatric intensive care.
Main Methods:
- A facility-based, unmatched case-control study was conducted in a PICU.
- Data were collected from 253 critically ill children (85 cases, 168 controls) between January 2011 and December 2021.
- Multivariable analysis identified factors significantly associated with AKI, using adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Main Results:
- Hypertension (aOR=5.36), shock (aOR=3.88), exposure to nephrotoxic drugs (aOR=4.09), sepsis/infection (aOR=3.36), nephritic syndrome (aOR=2.97), and mechanical ventilation (aOR=2.25) were significantly associated with AKI.
- The median age of participants was two years, with a slight female predominance in both cases and controls.
- These factors highlight the complex interplay of comorbidities and treatments contributing to AKI.
Conclusions:
- Sepsis/infection, hypertension, shock, nephrotoxic drugs, need for mechanical ventilation, and nephritic syndrome elevate the risk of AKI in critically ill children.
- AKI risk factors are often linked to the severity of illness and underlying conditions.
- Ensuring adequate renal perfusion in critically ill children with identified risk factors is vital for AKI prevention.
Background:
Acute kidney injury (AKI) is a serious health problem in critically ill children. It is associated with poor treatment outcomes and high morbidity and mortality rates. Globally, one in three critically ill children suffers from acute kidney injury. However, limited data are available in Africa, particularly Ethiopia, which highlighting the risk factors related to acute kidney injury. Therefore, this study aimed to identify the risk factors associated with acute kidney injury among critically ill children admitted to the pediatric intensive care unit (PICU) at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
Methods:
A facility-based unmatched case-control study was carried out on 253 (85 cases and 168 controls) critically ill children admitted to the pediatric intensive care unit from January 2011 to December 2021. Participants were selected using a systematic random sampling technique for the control group and all cases consecutively. Data were collected using a structured checklist. Data were entered using Epi data version 4.6 and analyzed using SPSS version 25. Multivariable analysis was carried out using the adjusted odds ratio (aOR) with a 95% confidence interval (CI) to identify associated factors with acute kidney injury. Statistical significance was set at P < 0.05.
Results:
The median age of the participants was two years. Approximately 55.6% of cases and 53.1% of controls were females. The diagnosis of hypertension (aOR = 5.36; 95% CI: 2.06-13.93), shock (aOR = 3.88, 95% CI: 1.85-8.12), exposure to nephrotoxic drugs (aOR = 4.09; 95% CI: 1. 45- 11.59), sepsis or infection aOR = 3.36; 95% CI: 1.42-7.99), nephritic syndrome (aOR = 2.97; 95% CI:1.19, 7.43), and use of mechanical ventilation aOR = 2.25, 95% CI: 1.12, 4.51) were significantly associated factors with acute kidney injury.
Conclusion:
The diagnosis of sepsis or infection, hypertension, shock, nephrotoxic drugs, demand for mechanical ventilation support, and nephritic syndrome increased the risk of AKI among critically ill children. Multiple risk factors for AKI are associated with illness and severity. All measures that ensure adequate renal perfusion must be taken in critically ill children with identified risk factors to prevent the development of AKI.
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