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Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study

  • Bjornstad, Erica C.1, 2
  • Muronya, William3
  • Smith, Zachary H.4, 5
  • Gibson, Keisha6
  • Mottl, Amy K.6
  • Charles, Anthony6, 7
  • Marshall, Stephen W.2, 8
  • Golightly, Yvonne M.2, 8
  • Munthali, Charles K.3
  • Gower, Emily W.2
  • 1 University of Alabama Birmingham, 1600 7th Avenue South, Lowder 516, Birmingham, AL, 35233, USA , Birmingham (United States)
  • 2 University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA , Chapel Hill (United States)
  • 3 Kamuzu Central Hospital, Lilongwe, Malawi , Lilongwe (Malawi)
  • 4 Univeristy of North Carolina Project Malawi, Lilongwe, Malawi , Lilongwe (Malawi)
  • 5 Stanford University School of Medicine, Stanford, CA, USA , Stanford (United States)
  • 6 University of North Carolina, Chapel Hill, NC, USA , Chapel Hill (United States)
  • 7 Malawi Surgical Initiative, Lilongwe, Malawi , Lilongwe (Malawi)
  • 8 University of North Carolina Injury Prevention Research Center, Carrboro, NC, USA , Carrboro (United States)
Published Article
BMC Nephrology
Springer (Biomed Central Ltd.)
Publication Date
Mar 14, 2020
DOI: 10.1186/s12882-020-01755-3
Springer Nature


BackgroundAcute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.MethodsProspective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI.ResultsWe analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n = 4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2–19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies.ConclusionsAKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.

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