INCIDENCE, PREDICTORS, AND EARLY OUTCOMES OF ACUTE KIDNEY INJURY AMONG HOSPITALIZED CHILDREN IN A RESOURCE LIMITED TERTIARY CARE CENTER
Main Article Content
Keywords
Acute kidney injury, pediatric AKI, KDIGO criteria, predictors, outcomes, resource-limited setting, Pakistan, sepsis, nephrotoxicity
Abstract
OBJECTIVE: To determine the incidence, identify independent predictors, and assess early clinical outcomes of acute kidney injury (AKI) among hospitalized children at a resource-limited tertiary care center in Pakistan.
MATERIALS AND METHODS: A prospective observational cohort study was conducted at the Pediatric Department of Sahara Medical College Hospital, Narowal, from January 2025 to July 2025. All children aged 28 days to 18 years admitted to general pediatric or pediatric ICU wards were screened. AKI was defined and staged using the modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria adapted for resource-limited settings using serum creatinine and urine output when available. Demographic, clinical, and laboratory variables were recorded. Multivariable logistic regression was used to identify predictors of AKI and its association with outcomes (prolonged hospitalization, mechanical ventilation, mortality).
RESULTS: Among 1,240 hospitalized children, 186 (15.0%) developed AKI. Of these, 112 (60.2%) had Stage 1, 48 (25.8%) Stage 2, and 26 (14.0%) Stage 3 AKI. Independent predictors of AKI included sepsis (aOR = 3.42, 95% CI: 2.11–5.54, p < 0.001), dehydration (aOR = 2.87, 95% CI: 1.76–4.68, p < 0.001), use of nephrotoxic drugs (aOR = 2.31, 95% CI: 1.42–3.75, p = 0.001), and baseline anemia (Hb < 9 g/dL; aOR = 1.94, 95% CI: 1.20–3.14, p = 0.007).
Children with AKI had significantly longer hospital stays (median 9 vs. 4 days, p < 0.001), higher rates of mechanical ventilation (22.6% vs. 3.1%, p < 0.001), and in-hospital mortality (16.1% vs. 1.8%, p < 0.001). All five statistical tables demonstrated significant associations (p < 0.05).
CONCLUSION: AKI affects 15% of hospitalized children in this resource-limited setting and is strongly associated with sepsis, dehydration, nephrotoxic exposure, and anemia. It independently predicts poor early outcomes, including mortality. Early recognition and mitigation of modifiable risk factors are critical to improving pediatric outcomes in similar settings.
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Muhammad Ramzan
Senior Registrar, Nephrology Department, Sahara Medical College, Narowal
Hafiz Muhammad Nasrullah
Assistant professor, Biochemistry Department, Sahara medical college Narowal
Muhammad uzair
Associate professor, Peadiatric Department, Sahara medical college Narowal
Mustansar Billah
Associate Professor, department of Community medicine, M Islam medical College Gujranwala
Faryad Hussain
Professor, Peadiatric Department, Lahore general hospital, Lahore
