Outcomes of Children with Acute Kidney Injury Admitted with Critical Illness to a Tertiary Hospital, in a sub-Saharan African country
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Date
2025
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Addis Ababa University
Abstract
Background:
Pediatric acute kidney injury (AKI) is increasingly recognized as a major cause of morbidity and mortality among hospitalized children, especially in low- and middle-income countries. Limited diagnostic capacity and delayed recognition often contribute to poor outcomes. Despite growing attention to AKI in adults, data in the pediatric population remain sparse in sub-Saharan Africa. This study aimed to determine treatment outcomes, describe the clinical patterns of pediatric AKI, and identify determinants using the Phoenix criteria.
Methods:
A hospital-based cross-sectional study was conducted among 360 pediatric patients admitted to the tertiary pediatric intensive care units. Demographic, clinical, and laboratory data were collected using a structured checklist. AKI was diagnosed and staged using the Phoenix (KDIGO-based) criteria, which incorporate changes in serum creatinine and urine output. Data were analyzed using SPSS version 26. Descriptive statistics were presented as frequencies and percentages, and associations between AKI and potential determinants were assessed through bivariate and multivariable logistic regression. A p-value <0.05 was considered statistically significant.
Results:
The overall prevalence of AKI was 28%, with stage 1, stage 2, and stage 3 comprising 7.5%, 11.1%, and 9.4% of cases, respectively. AKI was most common among children aged 1–5 years and slightly more prevalent in males. Sepsis was the most significant determinant, associated with a more than twofold increased risk of AKI (AOR = 1.26, p < 0.001). Additional factors associated with AKI included hypotension, shock, use of nephrotoxic medications, and underlying malignancy. Among children with AKI, 63.5% presented with oliguria or anuria. The mortality rate among AKI patients was 45.4%, compared to 9.5% in non-AKI patients. Only 1.9% of those who met dialysis criteria received renal replacement therapy, reflecting limited access to specialized care. At discharge, 18.6% of AKI patients had fully recovered kidney function, whereas 32.1% showed residual renal impairment.
Conclusion:
Pediatric AKI is common in hospitalized children and is strongly associated with sepsis, hemodynamic instability, and exposure to nephrotoxins. The high mortality and low renal recovery rates highlight the urgent need for early recognition, improved fluid and sepsis management, and expanded access to renal replacement therapies. Strengthening hospital-based AKI surveillance and nephrology consultation systems could reduce preventable AKI-related deaths in children.
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Keywords
acute kidney injury, pediatrics, determinant factors, mortality, Phoenix criteria, sub-Saharan Africa