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. 2018 May 1;13(5):e0196586.
doi: 10.1371/journal.pone.0196586. eCollection 2018.

Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study

Etienne Macedo  1 , Jorge Cerdá  2 , Sangeeta Hingorani  3 , Jiayi Hou  4 , Arvind Bagga  5 , Emmanuel Almeida Burdmann  6 , Michael Rocco V  7 , Ravindra Mehta L  1
Affiliations

Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study

Etienne Macedo et al. PLoS One. .

Abstract

Background: In low and middle-income countries, reliable data on the epidemiology of childhood acute kidney injury (AKI) is lacking. The Global Snapshot, conducted by the ISN "0by25" AKI initiative, was a world-wide cross-sectional, observational study to evaluate AKI in hospitalized patients. Here we report the pediatric results of this study.

Patients and methods: We prospectively collected data on children who met the Kidney Disease Improving Global Outcomes AKI criteria during a 10-week window in late 2014. AKI risk factors, etiological factors, management and outcomes were recorded using standardized forms and protocols. Countries were classified according to their 2014 gross national income (GNI) per person into high-income countries (HIC), upper-middle income countries (UMIC) and low and low-middle income countries (LLMIC). Need for renal replacement therapy, mortality, and renal recovery were assessed 7 days after AKI diagnosis or at hospital discharge, whichever came first.

Results: 92 centers from 41 countries collected data on 354 pediatric AKI patients; 53% of the children developed AKI while hospitalized and 47% in the community. The most common etiological factors for AKI differed across GNI categories as well as between patients with community-acquired vs. hospital-acquired AKI. Children from HIC were younger, and larger proportion of AKI in this group were due to post-surgical complications vs. other etiologies when compared to other income categories. In patients with hypotension as the cause of AKI, the adjusted risk of death was almost 10-fold higher compared to patients without hypotension as an etiological factor for AKI development. Mortality was similar within AKI stages in HIC and UMIC. In LLMIC, patients with the highest AKI level of severity had higher mortality than patients in higher income categories. Patients from LLMIC and UMIC had a 57-fold and 11 fold higher adjusted risk of death, respectively, compared to patients from HIC.

Conclusion: In resource-limited countries, pediatric AKI-associated mortality is disproportionately higher when compared to high-resource areas, especially among patients with more severe AKI.

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Conflict of interest statement

Competing Interests: Some of the support to the study has been provided through unrestricted grants from Astute Medical (San Diego, CA, USA), Danone Nutricia Research (Palaiseau, France) and Bellco (Mirandola, Italy). The grants were given to ISN and none of the authors received any direct payments from any of the entities. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. Patient distribution based on GNI category and geographical region.
Color based on Gross national income, size of marks based on number of patients enrolled by country. HIC: high income country; UMIC: upper middle-income country; LLMIC: low and low middle income country. This graphic was made in Tableau Desktop.
Fig 2
Fig 2. Mortality frequency in the overall cohort, and by AKI development location (community vs hospital acquired AKI), by need of ICU and renal replacement therapy.
HIC: high income country; UMIC: upper middle-income country; LLMIC: low and lower middle income country. P values refer to difference within the GNI groups.
See this image and copyright information in PMC

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