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Acute kidney injury and its association with in-hospital mortality among children with acute infections

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Abstract

Background

We investigated prevalence of acute kidney injury (AKI) at hospitalization and its association with in-hospital mortality among Ugandan children hospitalized with common acute infections, and predictors of mortality among AKI children.

Methods

We enrolled 2,055 children hospitalized with primary diagnoses of acute gastroenteritis, malaria, or pneumonia. Serum creatinine, albumin, electrolytes, hemoglobin, and urine protein were obtained on admission. Participants were assessed for AKI based on serum creatinine levels. Demographic and clinical data were obtained using a primary care provider survey and medical chart review. Logistic regression was used to determine predictors of in-hospital mortality.

Results

A total of 278 (13.5 %) of children had AKI on admission; for 76.2 %, AKI was stage 2 (98/278) or stage 3 (114/278) defined as serum creatinine >2- or 3-fold above normal upper limit for age, respectively. AKI prevalence was particularly high in gastroenteritis (28.6 %) and underweight children (20.7 %). Twenty-five percent of children with AKI died during hospitalization, compared to 9.9 % with no AKI (adjusted odds ratio (aOR) 3.5 (95 % CI, 2.2–5.5)). In-hospital mortality risk did not differ by AKI stage. Predictors of in-hospital mortality among AKI children included primary diagnosis of pneumonia, aOR 4.5 (95 % CI, 1.8–11.2); proteinuria, aOR = 2.1 (95 % CI, 1.0–4.9) and positive human immunodeficiency virus (HIV) status, aOR 5.0 (95 % CI, 2.0–12.9).

Conclusions

Among children hospitalized with gastroenteritis, malaria, or pneumonia, AKI at admission was common and associated with high in-hospital mortality.

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Acknowledgments

We thank the study participants and the study staff at Mulago Hospital. We are also grateful to Gary Schoch and Elizabeth Soll for setting up the database and to Krista Yuhas for the technical support with the statistical analyses.

Financial support

This study was funded by a grant from the Washington Global Health Alliance, which was administered by the Seattle Children’s Hospital Research Institute.

Potential conflicts of interest

The authors declare that they have no competing interests.

Funding

This study was funded by the Washington Global Health Alliance.

Role of funding

The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript. The authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. This study was approved by the Makerere University Research and Ethics Committee and the Seattle Children’s Institutional Review Board (FWA00002443).

Author information

Author notes

  1. Allison A. Eddy

    Present address: Department of Pediatrics, University of British Columbia, BC Children’s Hospital, 2D15-4480 Oak Street, Vancouver, BC V6H 3V4, Canada

Authors and Affiliations

  1. Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA

    Peace D. Imani & Noel S. Weiss

  2. Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda

    Peace D. Imani & Amos Odiit

  3. Seattle Children’s Hospital and Research Institute and Department of Pediatrics, University of Washington, 4800 Sandpoint Way NE, A-7931, Seattle, WA, 98105, USA

    Sangeeta R. Hingorani & Allison A. Eddy

Authors
  1. Peace D. Imani
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  2. Amos Odiit
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  3. Sangeeta R. Hingorani
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  4. Noel S. Weiss
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  5. Allison A. Eddy
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Corresponding author

Correspondence to Allison A. Eddy.

Additional information

Dr. Imani and Dr. Odiit contributed equally to this paper.

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Imani, P.D., Odiit, A., Hingorani, S.R. et al. Acute kidney injury and its association with in-hospital mortality among children with acute infections. Pediatr Nephrol 28, 2199–2206 (2013). https://doi.org/10.1007/s00467-013-2544-2

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  • DOI: https://doi.org/10.1007/s00467-013-2544-2

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