Document Type

Article

Department

Paediatrics and Child Health (East Africa)

Abstract

Background: Children with sickle cell anemia (SCA) are at increased risk of acute kidney injury (AKI) that may lead to death or chronic kidney disease. This study evaluated AKI prevalence and risk factors in children with SCA hospitalized with a vaso-occlusive crisis (VOC) in a low-resource setting. Further, we evaluated whether modifcations to the Kidney Disease: Improving Global Outcomes (KDIGO) defnition would infuence clinical outcomes of AKI in children with SCA hospitalized with a VOC.

Methods: We prospectively enrolled 185 children from 2 – 18 years of age with SCA (Hemoglobin SS) hospitalized with a VOC at a tertiary hospital in Uganda. Kidney function was assessed on admission, 24–48 h of hospitalization, and day 7 or discharge. Creatinine was measured enzymatically using an isotype-dilution mass spectrometry traceable method. AKI was defned using the original-KDIGO defnition as≥1.5-fold change in creatinine within seven days or an absolute change of≥0.3 mg/dl within 48 h. The SCA modifed-KDIGO (sKDIGO) defnition excluded children with a 1.5-fold change in creatinine from 0.2 mg/dL to 0.3 mg/dL.

Results: Using KDIGO, 90/185 (48.7%) children had AKI with 61/185 (33.0%) AKI cases present on admission, and 29/124 (23.4%) cases of incident AKI. Overall, 23 children with AKI had a 1.5-fold increase in creatinine from 0.2 mg/ dL to 0.3 m/dL. Using the sKDIGO-defnition, 67/185 (36.2%) children had AKI with 43/185 (23.2%) cases on admission, and 24/142 (16.9%) cases of incident AKI. The sKDIGO defnition, but not the original-KDIGO defnition, was associated with increased mortality (0.9% vs. 7.5%, p=0.024). Using logistic regression, AKI risk factors included age (aOR, 1.10, 95% CI 1.10, 1.20), hypovolemia (aOR, 2.98, 95% CI 1.08, 8.23), tender hepatomegaly (aOR, 2.46, 95% CI 1.05, 5.81), and infection (aOR, 2.63, 95% CI 1.19, 5.81) (p<0.05).

Conclusion: These results demonstrate that AKI is a common complication in children with SCA admitted with VOC. The sKDIGO defnition of AKI in children with SCA was a better predictor of clinical outcomes in children. There is need for promotion of targeted interventions to ensure early identifcation and treatment of AKI in children with SCA.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

BMC nephrology

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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