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- Title
Acute kidney injury requiring dialysis in children: a multicentric, emerging country perspective.
- Authors
Cleto-Yamane, Thais Lira; Gomes, Conrado Lysandro R.; Koch-Nogueira, Paulo Cesar; Suassuna, José Hermógenes Rocco
- Abstract
Background: Acute kidney injury (AKI) is a life-threatening condition, especially in extreme age groups and when kidney replacement therapy (KRT) is necessary. Studies worldwide report mortality rates of 10–63% in pediatric patients undergoing KRT. Methods: Over 13 years, this multicenter study analyzed data from 693 patients with AKI, all receiving KRT, across 74 hospitals and medical facilities in Rio de Janeiro, Brazil. Results: The majority were male (59.5%), under one year old (55.6%), and treated in private hospitals (76.5%). Sixty-six percent had comorbidities. Pneumonia and congenital heart disease were the most common admission diagnoses (21.5% and 20.2%, respectively). The mortality rate was 65.2%, with lower rates in patients over 12 years (50%). Older age was protective (HR: 2.35, IQR [1.52–3.62] for neonates), and primary kidney disease had a three-fold lower mortality rate. ICU team experience (HR: 0.74, IQR [0.60–0.91]) correlated with lower mortality, particularly in hospitals treating 20 or more patients. Among the deceased, 40% died within 48 h of KRT initiation, suggesting possible late referral or treatment futility. Conclusions: This study confirms the high mortality in pediatric dialytic AKI in middle-income countries, underlining early mortality and offering critical insights for improving outcomes.
- Subjects
BRAZIL; PNEUMONIA; CONGENITAL heart disease; MIDDLE-income countries; THERAPEUTICS; RENAL replacement therapy; ACUTE kidney failure; HEMODIALYSIS; CATASTROPHIC illness; DESCRIPTIVE statistics; CAUSES of death; AGE distribution; PEDIATRICS; RESEARCH; HEALTH equity; COMORBIDITY; LOW-income countries; CHILDREN
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 7, p2253
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-024-06305-9