Risks and recognition of acute kidney injury in children: a local snapshot of an Academic Hospital complex in central South Africa
i. Introduction and aim: Acute kidney injury (AKI) plays a major role in poor patient outcomes and is associated with increased morbidity and mortality. Epidemiological data of children with AKI in low-resource settings are poorly described in the literature. This study aimed to assess the AKI incidence, risks and recognition in hospitalised children in Bloemfontein. ii. Methods: We conducted an observational prospective cross-sectional study of all children admitted to the Bloemfontein Academic Hospital Complex on a chosen "index day". All patients aged 1 month to 13 years admitted to the Bloemfontein Academic Hospital Complex on the "index day" were screened for eligibility for entry into the study. We used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define acute kidney injury. The identified AKI cases were followed up one week later to determine outcome. iii. Results: A total of 128 patients were screened and 58 patients were enrolled on the "index day". The researcher identified acute kidney injury in 14 of the 58 enrolled patients, of which the primary clinical team only identified three. Anaemia (p=0.005, OR 7.8, 95% CI 1.5-39.9) was recognised as the most significant inherent risk factor for the development of acute kidney injury. Sepsis (p=0.003, OR 7.5, 95% CI 1.7-38.1) and circulatory shock (p=0.002, OR 23.9, 95% CI 2.1-1154.7) were the most prominent aetiologies. iv. Conclusion: Acute kidney injury is common and largely unrecognised despite risk factors in our setting. We identified aetiological factors common to larger, multi centre studies. Additional strategies are needed to raise awareness of acute kidney injury in central South Africa.