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Acute kidney injury requiring dialysis in children: a multicentric, emerging country perspective
Thais Lira Cleto-Yamane1,2, Conrado Lysandro R Gomes3,4, Paulo Cesar Koch-Nogueira5
1Clinical and Academic Unit of Nephrology, Pedro Ernesto University Hospital, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil. thaiscleto@yahoo.com.br.
Insights
Pediatric acute kidney injury (AKI) requiring kidney replacement therapy (KRT) has a high mortality rate, especially in younger children. Early mortality and factors like ICU team experience are critical for improving outcomes in middle-income countries.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- Acute kidney injury (AKI) poses a significant threat, particularly in neonates and children requiring kidney replacement therapy (KRT).
- Global mortality rates for pediatric KRT patients range widely from 10% to 63%.
Purpose of the Study:
- To analyze the outcomes and mortality rates of pediatric patients with AKI undergoing KRT in middle-income countries.
- To identify risk factors and protective elements influencing survival in this vulnerable population.
Main Methods:
- A multicenter study analyzed data from 693 pediatric patients with AKI receiving KRT over 13 years in Rio de Janeiro, Brazil.
- Data were collected from 74 hospitals, including patient demographics, comorbidities, diagnoses, and treatment details.
Main Results:
- The overall mortality rate was 65.2%, with higher rates in infants (55.6% under one year old).
- Older age and primary kidney disease were associated with lower mortality, while comorbidities were common (66%).
- Intensive care unit (ICU) team experience correlated with reduced mortality, especially in high-volume centers. 40% of deaths occurred within 48 hours of KRT initiation.
Conclusions:
- Pediatric AKI requiring KRT is associated with high mortality in middle-income settings.
- Early mortality and factors like late referral or treatment futility warrant further investigation to improve patient outcomes.
Background:
Acute kidney injury (AKI) is a life-threatening condition, especially in extreme age groups and when kidney replacement therapy (KRT) is necessary. Studies worldwide report mortality rates of 10-63% in pediatric patients undergoing KRT.
Methods:
Over 13 years, this multicenter study analyzed data from 693 patients with AKI, all receiving KRT, across 74 hospitals and medical facilities in Rio de Janeiro, Brazil.
Results:
The majority were male (59.5%), under one year old (55.6%), and treated in private hospitals (76.5%). Sixty-six percent had comorbidities. Pneumonia and congenital heart disease were the most common admission diagnoses (21.5% and 20.2%, respectively). The mortality rate was 65.2%, with lower rates in patients over 12 years (50%). Older age was protective (HR: 2.35, IQR [1.52-3.62] for neonates), and primary kidney disease had a three-fold lower mortality rate. ICU team experience (HR: 0.74, IQR [0.60-0.91]) correlated with lower mortality, particularly in hospitals treating 20 or more patients. Among the deceased, 40% died within 48 h of KRT initiation, suggesting possible late referral or treatment futility.
Conclusions:
This study confirms the high mortality in pediatric dialytic AKI in middle-income countries, underlining early mortality and offering critical insights for improving outcomes.
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