Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia.
Department of Paediatrics, University Teaching Hospitals-Children's Hospital, Lusaka, Zambia.
PLoS One. 2023 Oct 25;18(10):e0293037. doi: 10.1371/journal.pone.0293037. eCollection 2023.
Whilst malaria is a prominent aetiology associated with acute kidney injury (AKI) in many parts of Africa, a shift in the traditional AKI aetiologies has been witnessed in sections of the continent. Additionally, limited access to dialysis worsens patient outcomes in these low-resource settings. This retrospective cross-sectional study aimed to determine the associated aetiologies, predictors of need for dialysis and malaria-associated AKI (MAKI), and outcomes of AKI and dialysis among children evaluated by the renal service in Lusaka, Zambia.
The study sampled all children aged 16 years or below, diagnosed with AKI between 2017 and 2021, by the renal unit at the University Teaching Hospitals- Children's Hospital (UTH-CH), and retrospectively abstracted their records for exposures and outcomes. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Frequency and percentage distributions were used to describe the occurrence of AKI aetiologies and treatment outcomes. Predictors of the need for dialysis, MAKI, and poor treatment outcome were identified by using multivariable logistic regression models.
A total of 126 children diagnosed with AKI were included in this study. Malaria was the most frequent aetiology of AKI(61.1% (77/126, 95% Confidence Interval (CI): 52.0%-69.7%)). Of the 126 children with AKI, 74.6% (94) underwent dialysis. Predictors of the need for dialysis were oliguria (p = 0.0024; Odds ratio (OR) = 7.5, 95% CI: 2.1-27.7) and anuria (p = 0.0211; OR = 6.4, 95% CI = 1.3, 30.7). A fifth (18.3%, 23/126) of the children developed chronic kidney disease (CKD), 5.6% (7/126) died and, a year later, 77% (97/126) were lost to follow-up.
At UTH-CH, malaria is the most frequent aetiology among children with AKI undergoing dialysis and children from low-medium malaria incidence areas are at risk; a considerable proportion of children with AKI need dialysis and Tenchoff catheter use in AKI is advocated.
在非洲的许多地区，疟疾是导致急性肾损伤（AKI）的主要病因，但在该大陆的某些地区，传统的 AKI 病因已经发生变化。此外，在这些资源匮乏的环境中，透析机会有限，这会使患者的预后恶化。本回顾性横断面研究旨在确定赞比亚卢萨卡肾脏科评估的儿童 AKI 的相关病因、需要透析的预测因素以及疟疾相关 AKI（MAKI）和透析的结局。
该研究对肾脏科在 2017 年至 2021 年间诊断为 AKI 的所有 16 岁及以下儿童进行了抽样，回顾性地提取了他们的暴露和结局记录。AKI 采用肾脏病改善全球结局（KDIGO）2012 标准定义。使用频率和百分比分布来描述 AKI 病因和治疗结局的发生情况。使用多变量逻辑回归模型确定需要透析、MAKI 和治疗结局不良的预测因素。
本研究共纳入 126 例 AKI 患儿。疟疾是 AKI 最常见的病因（61.1%（77/126，95%置信区间：52.0%-69.7%））。在 126 例 AKI 患儿中，74.6%（94 例）接受了透析。需要透析的预测因素为少尿（p=0.0024；比值比（OR）=7.5，95%CI：2.1-27.7）和无尿（p=0.0211；OR=6.4，95%CI=1.3,30.7）。五分之一（18.3%，23/126）的患儿发展为慢性肾脏病（CKD），5.6%（7/126）死亡，一年后，77%（97/126）失访。
在 UTH-CH，接受透析的 AKI 患儿中，疟疾是最常见的病因，来自中低疟疾发病率地区的儿童面临风险；相当一部分 AKI 患儿需要透析，提倡在 AKI 中使用 Tenchoff 导管。
