Risk Factors, Epidemiology and Outcome of Acute Kidney Injury among Pediatric Admissions in a Primary Health Facility in Cameroon

Background and aim: Data on the epidemiology of acute kidney injury (AKI) in Sub-Saharan Africa mainly originates from studies in large tertiary hospitals with nephrology units. Little is known about what happens in primary health structures without nephrology care, especially in the paediatric population. We sought describe the epidemiology of AKI in children at risk in district hospitals in Cameroon. Methods: We prospectively screened consenting children aged 2-18 years of age in paediatric wards of 3 large urban district hospitals over a period of 4 months. We identified children with AKI risk factors on admission then screened for AKI using the creatinine based modified Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Participants with AKI were then followed up till discharge. Outcomes of interest were need and access to dialysis, and renal recovery on hospital discharge. Written assent was obtained from parents or caregivers. Results: Among the 211 children admitted during the study period, 82% (n=173) were at risk of AKI, of whom 19 (11%) did not consent. Of the 154 children included 54.5% were males and the median age was 6 years [IQ 3-10]. Sepsis and volume depletion were the most common risk factors of AKI. The incidence of AKI was 12.3% (n=19). AKI was mostly community acquired and 47.4% (n=9) patients were in KDIGO stage 3. Pre-renal AKI and acute tubular necrosis accounted for 63.2% and 36.8% respectively. Gastro-intestinal losses, malaria, bacterial sepsis and nephrotoxins were the common aetiologies of AKI. The lone patient in need of dialysis died without it. On discharge, 71.7% of AKI had complete recovery renal function. Conclusion: Risk factors of AKI are very common in children on admission in general district hospitals in Cameroon. At least one out of 10 admitted children with AKI risk factors will have AKI. AKI is caused largely by preventable community acquired conditions such as diarrhoeal diseases and malaria. Efforts should be made to raise awareness of primary health caregivers about risk assessment, prevention, early recognition and management of AKI in children.