Magnitude and associated factors of acute kidney injury among children admitted to pediatric intensive care unit of Hiwot Fana specialized University hospital, Eastern Ethiopia

Abstract

Background: Acute kidney injury is common in hospitalized children and this study characterizes acute kidney injury in hospitalized children in our PICU. Despite the significance of the disease the magnitude of the problem is not known in our setup. Objective: To determine the magnitude and associated factors with acute kidney injury in Hiwot Fana Specialized University Hospital, pediatric intensive care unit in the year 2021. Methods and Materials: One-year Institutional based cross-sectional study was using data from medical records was collected among 200 pediatric patients admitted to Hiwot Fana specialized Hospital pediatric ICU. Data were using a structured questionnaire of patients who met the inclusion criteria. Acute kidney injury was diagnosed using the KIDGO 2012 criteria based on urine output and serum creatinine levels. Data were collected using a structured questionnaire entered into Epi Data version 3.1, transferred, and analyzed using Stata version 17. Descriptive statistics, including frequency, proportions, means, and standard deviations, were calculated for continuous variables. The proportion of AKI among ICU admissions was determined. Bivariate analysis was performed to determine the correlation between independent variables and AKI. Variables with a P value less than 0.25 were included in multivariate analysis, with a P value less than 0.05 considered significant. Results: Out of the 370 records in the registration book, only 200 met eligibility criteria, with the majority missing or from different wards. Among the eligible records, 52% were male, and 48% were female, with 66% aged 1 month to 4 years, 31% aged 5 to 14 years, and 3% aged 15-16 years. Of the 200 admitted, 16.5% developed Acute Kidney Injury (AKI); 52% were male, 48% female, 66.7% from rural areas, and 33.3% from urban settings. AKI stages included 8% stage 1, 2% stage 2, and 6.5% stage 3. In line with an Indian study, the AKI incidence was 24%. Among those with AKI, 15% had heart failure, 0.2% had malignancy, 24% had sepsis, and 51% had severe acute malnutrition. Another study showed heart failure in 14.3%, malignancy in 34.6%, sepsis in 30%, and other comorbidities in 22%. Of the AKI cases, 52.6% resulted in 17 deaths, with 68% associated with stages 2 and 3 AKI. A study by Damte Shimelis reported 43.5% deaths, 31.8% in stages 2 and 3. Conclusion: There is a notable incidence of AKI, with a majority of patients originating from rural areas. While stage 1 AKI was the most frequently observed, stages 2 and 3 were more strongly linked to mortality. The prevalence of mortality associated with AKI is substantial. The most prevalent comorbidity were severe acute malnutrition and sepsis. Budget: 27,600 birr Source of budget: Self