Risk Factors Associated with Outcome of Peritoneal Dialysis and Hemodialaysis Done for Patient with Acute Kidney Injury in Tikur Anbessa Hospital Pediatrics Intensive Care Unit From January 2018 To Dec 2023.
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Date
2024-04
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Addis Ababa University
Abstract
Back ground: Acute kidney injury is an abrupt loss of kidney function that results in a decline
in glomerular filtration rate, retention of urea and other nitrogenous waste products, and
deregulation of extracellular volume and electrolytes The AKI is a serious condition, with a multi
factorial etiology In numerous cases, and with variable mortality, reaching further than 60% in
patient who took dialysis. Morbidity and mortality is especially high in sub-Saharan Africa where
access to dialysis is veritably limited. Identifying modifiable risk factor associated with outcome
of dialysis may improve the outcome Objective: - To identify the risk factors associated with the
outcomes of HD and PD among patient with acute kidney injury at Tikure Anbessa hospital
pediatric intensive care unit from Jan 2018 to Dec 2023
Method:-a retrospective cohort study will be conducted on risk factors associated with
outcomes of hemodyalisis and peritoneal dialysis done for patient with AKI in TASH PICU from
Jan 2018 to Dec 2023 with structured questionnaire to collect the data from the patients’ card.
Data checked, gutted and Inputted into SPSS interpretation 27.0 software version for analysis. P
values of (P <0.005) will be considered statistically significant. Paired t test was used to
compare blood biochemistry before initiation and at the end of dialysis and Multinomial logistic
regression was used to determine the relation between the different independent variables to
final outcome.
Results:-there were 30 children in this study Most of patient were male in 56.7% .Most of the
cases who undertake peritoneal dialysis were less than 5 years (59.1%) whereas greater than 10
years for those who took hemodyalisis .The majority were from outside of Addis Ababa which
is 24 (80%) . The highest cause of AKI was RPGN in 20 (66.6%) from this PSGN was the cause
in 50% but the remaining cause of RPGN was not identified, followed by ATN and lupus
nephritis each in (10%) HUS in (6.5%), malignancy and ATIN each in (3.3%).there is a
statistically significant mean difference on serum BUN, creatinine and potassium before
initiation and after the last dialysis with P value of (P< 0.001). In hospital mortality rate was in
40% and low urine output was significantly associated with mortality with P value of (P< 0.037).
In these study most of peritoneal dialysis was done with locally prepared solution with Ringer
lactate and Dextrose and Hemodyalisis was done on adult side.
Complication encountered in 17 (56.7%) of patients from this 13 (60%) associated with
peritoneal dialysis and 4 (50%) associated with hemodyalisis Most common complication
associated with peritoneal dialysis were catheter leakage 6 (26%) then followed by catheter
blockage 5 (21.7%) and peritonitis in 5 (21.7% ), omental herniation 2(8.6%), hyperglycemia 2
(8.6%) presence of complication was not associated with mortality with P value of 0.9
Conclusion:-our finding revealed that majority of pediatrics AKI patients had successful
restoration of kidney function after dialysis which was comparable to other study. Low urine
output at the end of dialysis was the independent predictor for death, which was supported by
other study. In poor resource setting like in our country improvised peritoneal dialysis was safe
and effective method to manage pediatrics AKI. It is recommended to have more trained
medical staff in pediatrics Nephrology and extending PD service to other parts of the country. It
is recommended to conduct well-structured prospective study including the other referral
hospital in the country with adequate sample size to better assess the outcome of dialysis
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Keywords
Kidney injury