Predictors of dialysis and death among paediatric renal disease patients: A 14-year retrospective study at Korle Bu Teaching Hospital, Ghana.

Abstract

Abstract Introduction: Paediatric nephropathy, a condition associated with significant morbidity and mortality, is increasing in developing countries. Data on paediatric renal diseases are insufficient in Ghana despite the risk it poses. This study assessed the pattern, spectrum, outcome, and predictors of dialysis and death among paediatric renal disease patients at Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Methodology: Among children aged 0-17 years on admission at the Child Health Department of KBTH, a retrospective hospital-based study was conducted. Demographic characteristics, clinical data including type, cause, duration, and symptoms of renal diseases, laboratory data (haemtological and biochemical), information on dialysis and treatment outcome were obtained from their records. Data were analyzed accordingly using STATA software version 15.1. Results: A total of 353 children with renal diseases were seen during the study period (2009-2022) (mean age of 5.91 ±3.99), with 217(62.18%) being males. The most common renal diseases were nephrotic syndrome 141(39.94%), acute kidney injury (AKI) 87(24.65%) and acute glomerulonephritis 47(13.31%). Others included polycystic kidney disease (0.85%), lupus nephritis (0.57%), and others (ureterostomies, bladder calculus, and dilated ectopic renal pelvis)(1.70%). Idiopathic causes (26.35%) were the major cause of renal diseases followed by intravascular haemolysis (20.11%), infection (18.70%), and hypertension (17.00%). Swelling (76.88%), facial puffiness (39.02%), fever (34.97%), and abdominal distension (24.57%) were the most common symptoms. A death prevalence of 16.43% resulting mostly from AKI (5.95%), acute on chronic kidney disease (4.25%), and CKD (2.55%) was observed at KBTH whilst 7.37% were on dialysis. Predictors of dialysis included female gender, high urea levels and acute on chronic kidney disease whilst being admitted for a month or less and more than 5 years, high white blood cell count (WBC), acute on chronic kidney disease, and renal impairment were significant predictors of death among children with renal diseases. Conclusion: Paediatric renal diseases at KBTH were dominated by nephrotic syndrome and AKI. High WBC count, acute on chronic kidney disease, and renal impairment were significantly associated with death among children with renal diseases. Therefore, much attention should be paid to these parameters during their care.