Acute kidney injury requiring dialysis in children: a multicentric, emerging country perspective

Abstract

Abstract Background Acute kidney injury (AKI) is a life-threatening condition, particularly in patients at the extremes of age and when kidney replacement therapy (KRT) is required. Worldwide data report 10% and 63% mortality rates in pediatric patients undergoing KRT.Methods Throughout a 13-year study period this study analyzed data from 693 patients with AKI in Rio de Janeiro, Brazil.Results Most patients were male (59.5%), younger than one year of age (55.6%) and were treated at private governance hospitals (76.5%). Sixty-six percent of the subjects had one or more coexisting conditions. Upon admission, pneumonia was the most frequent primary diagnosis, followed by congenital heart disease (21.5% and 20.2%, respectively). The mortality rate was 65.2%, with lower mortality observed in patients over 12 (50%). Older age was a protective factor against death (HR: 2.35, IQR [1.52–3.62] for neonates). Primary kidney disease was associated with at least a three-fold lower mortality rate. Additionally, the experience of the ICU team was associated with lower mortality (HR: 0.74, IQR [0.60–0.91]), when the hospital treated 20 or more patients over the study period. Among the patients who died, 40% died within 48 hours of KRT initiation.Conclusions This study confirms the high mortality rate associated with dialytic AKI in pediatric patients, in middle-income countries. It also highlights early mortality, which may indicate late referral or futility of treatment. These results provide essential data on the main aspects of this disease and may contribute to the planning of measures to improve the outcomes of this condition.