Ademola Adebowale D, Asinobi Adanze O, Ekpe-Adewuyi Esther, Ayede Adejumoke I, Ajayi Samuel O, Raji Yemi R, Salako Babatunde L, James Matthew, Zappitelli Michael, Samuel Susan M
Department of Pediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Oyo State, Nigeria.
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Clin Kidney J. 2018 Dec 15;12(4):521-526. doi: 10.1093/ckj/sfy120. eCollection 2019 Aug.
Epidemiological data on paediatric acute kidney injury (AKI) in sub-Saharan Africa are limited and largely retrospective. We performed a prospective study of AKI among patients admitted through the emergency room.
Children admitted to the post-neonatal emergency room of the University College Hospital, Ibadan, Nigeria between February 2016 and January 2017 were studied. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine criteria. AKI ascertainment relied on serum creatinine measurements carried out in routine care by post-admission Day 1. We compared in-hospital mortality by post-admission Day 7 for patients with and without AKI (no-AKI).
Of the 1344 children admitted to the emergency room, 331 were included in the study. AKI occurred in 112 patients (33.8%) with a median age of 3.1 years [interquartile range (IQR) 0.9-9.4] and was Stage 3 in 50.5% of the cases. The no-AKI group had a median age of 1.8 (IQR 0.7-5.8) years. The underlying diagnoses in patients with AKI were sepsis (33.0%), malaria (12.5%) and primary renal disorders (13.4%). Twenty-four of the patients with AKI underwent dialysis: haemodialysis in 20 and peritoneal dialysis in 4. By Day 7 of admission, 7 of 98 (7.1%) patients in the AKI group had died compared with 5 of 175 (2.9%) patients in the no-AKI group [odds ratio 2.6 (95% confidence interval 0.8-8.5)]. Outcome data were not available for 58 (17.5%) patients.
AKI is common among paediatric emergency room admissions in a tertiary care hospital in sub-Saharan Africa. It is associated with high mortality risk that may be worse in settings without dialysis.
撒哈拉以南非洲地区儿童急性肾损伤（AKI）的流行病学数据有限，且大多为回顾性研究。我们对通过急诊室入院的患者进行了一项关于AKI的前瞻性研究。
对2016年2月至2017年1月期间在尼日利亚伊巴丹大学学院医院新生儿后急诊室入院的儿童进行研究。AKI根据改善全球肾脏病预后组织（KDIGO）的血清肌酐标准进行定义。AKI的确定依赖于入院后第1天常规护理中进行的血清肌酐测量。我们比较了发生AKI的患者和未发生AKI（非AKI）的患者在入院后第7天的院内死亡率。
在1344名急诊室入院的儿童中，331名被纳入研究。112名患者（33.8%）发生AKI，中位年龄为3.1岁[四分位间距（IQR）0.9 - 9.4]，其中50.5%的病例为3期。非AKI组中位年龄为1.8岁（IQR 0.7 - 5.8）。AKI患者的潜在诊断为败血症（33.0%）、疟疾（12.5%）和原发性肾脏疾病（13.4%）。24名AKI患者接受了透析：20名接受血液透析，4名接受腹膜透析。入院第7天时，AKI组98名患者中有7名（7.1%）死亡，而非AKI组175名患者中有5名（2.9%）死亡[比值比2.6（95%置信区间0.8 - 8.5）]。58名（17.5%）患者没有结局数据。
在撒哈拉以南非洲地区一家三级护理医院的儿科急诊室入院患者中，AKI很常见。它与高死亡风险相关，在没有透析的情况下风险可能更高。
