UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Children's Hospital Association, Lenexa, KS, USA.
Br J Haematol. 2020 May;189(3):559-565. doi: 10.1111/bjh.16384. Epub 2020 Feb 6.
Renal disease is a common complication experienced by patients with sickle cell disease (SCD), though the epidemiology of acute kidney injury (AKI) in paediatric patients and its impact on long-term renal outcomes is unclear. We utilized the Pediatric Health Information System (PHIS) to identify inpatient encounters of paediatric patients with SCD admitted for vaso-occlusive pain crisis (VOC). Overall, 1·4% of patients experienced at least one episode of AKI and 2·5% of admissions were complicated by AKI. Patients with at least one episode of AKI were more likely to be adolescents or young adults at the time of their initial admission, had increased rates of admission to the ICU, longer lengths of stay, increased costs of hospitalization, increased risk of readmission and increased rates of SCD-related comorbidities. Generalized estimating equation modelling demonstrated that increasing age, history of hypertension, history of haematuria and history of chronic kidney disease were associated with increased odds of developing AKI, though hydroxycarbamide use (OR 0·64, 95% CI 0·44-0·94) was protective. Episodes of AKI during hospitalization in children with SCD are associated with increased morbidity and utilization of hospital resources. Increasing the use of hydroxycarbamide may decrease the likelihood of this complication.
肾脏疾病是镰状细胞病（SCD）患者常见的并发症，但儿科患者急性肾损伤（AKI）的流行病学及其对长期肾脏结局的影响尚不清楚。我们利用儿科健康信息系统（PHIS）识别因血管阻塞性疼痛危象（VOC）住院的 SCD 儿科患者的住院记录。总体而言，1.4%的患者至少经历过一次 AKI 发作，2.5%的住院病例并发 AKI。发生至少一次 AKI 发作的患者在首次入院时更有可能是青少年或年轻人，他们入住 ICU 的比例更高，住院时间更长，住院费用更高，再入院风险更高，且 SCD 相关合并症的发生率更高。广义估计方程模型显示，年龄增长、高血压病史、血尿病史和慢性肾脏病病史与 AKI 发病风险增加相关，而羟基脲的使用（OR 0.64，95%CI 0.44-0.94）具有保护作用。SCD 儿童住院期间 AKI 发作与发病率增加和医院资源利用增加相关。增加羟基脲的使用可能会降低这种并发症的发生几率。
