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Gülçek ÖN, Gülhan B, Kesici S, Kurt Şükür ED, Hayran M, Ozaltin F, Duzova A, Bayrakçı B, Topaloglu R. Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg. Pediatr Nephrol 2023; 38:3811-3821. [PMID: 37195543 PMCID: PMC10189211 DOI: 10.1007/s00467-023-06013-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). METHODS Patients with history of paKST (CKRT, HD, PD) weighing < 15 kg and ≥ 6 months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. RESULTS 109 patients (57 females) were included. Median age at paKST was 10.1 months (IQR: 2-27 months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3 days (IQR: 2-9.5 days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1 years, 34 patients were evaluated at mean age 4.7 ± 2.4 years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13-0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m2 and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90 ml/min/1.73m2, and/or proteinuria) at last visit. Among 28 patients on paKST < 32 months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32 months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014). CONCLUSIONS Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ömer Nazım Gülçek
- Faculty of Medicine, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Bora Gülhan
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye.
| | - Selman Kesici
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Eda Didem Kurt Şükür
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University, Ankara, Türkiye
| | - Fatih Ozaltin
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
- Nephrogenetics Laboratory, Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
- Department of Bioinformatics, Institute of Health Sciences, Hacettepe University, Ankara, 06100, Türkiye
| | - Ali Duzova
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
| | - Benan Bayrakçı
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Rezan Topaloglu
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
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Alao MA, Ibrahim OR, Briggs DC, Sobande J, Rasaki A, Nnamani KO, Ademola AD, Tongo OO, Udoudo NUA, Usman HA, Akinkunmi BF, Asinobi AO. A Protocol for the Nigerian Neonatal Acute Kidney Injury Continuum Prospective Study. Kidney Int Rep 2023; 8:2478-2481. [PMID: 38025222 PMCID: PMC10658228 DOI: 10.1016/j.ekir.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Michael Abel Alao
- Department of Paediatrics, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Oyo State, Nigeria
| | - Olayinka Rasheed Ibrahim
- Department of Pediatrics, University of Ilorin Teaching Hospital and University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Datonye Christopher Briggs
- Faculty of Clinical Sciences, College of Medical Sciences Rivers State University and Department of Paediatrics, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - James Sobande
- University College Hospital, Ibadan, Oyo State, Nigeria
| | - Aliu Rasaki
- Gombe State University/ Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Kenechi Ogbodo Nnamani
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Adebowale Debo Ademola
- Department of Paediatrics, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Oyo State, Nigeria
| | - Olukemi Oluwatoyin Tongo
- Department of Paediatrics, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Oyo State, Nigeria
| | | | | | - Bola Francis Akinkunmi
- Department of Paediatrics, University of Medical Sciences/Teaching Hospital Ondo, Ondo, Nigeria
| | - Adanze Onyenonachi Asinobi
- Department of Paediatrics, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Oyo State, Nigeria
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Ademola AD, Asinobi AO, Alao MA, Wade AW. Paediatric Dialysis at a Tertiary Hospital in South-West Nigeria: A 4-Year Report. Blood Purif 2022; 51:1015-1021. [PMID: 35483325 DOI: 10.1159/000523746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dialysis is potentially lifesaving in children with acute kidney injury (AKI) or chronic kidney disease (CKD), but availability is limited in low-income countries and lower-middle-income countries (LMICs). METHODS In the present study, we perform a 4-year study of patients who received peritoneal dialysis (PD) or haemodialysis (HD) at the Paediatric Nephrology Unit of the University College Hospital Ibadan, Nigeria. Subgroup analysis was performed on patients with sepsis or malaria AKI who underwent HD or PD for predictors of in-hospital mortality. RESULTS A total of 167 children aged 7 days to 18 years, median 7 (interquartile range 3-12) years, (60.5% males) were studied. In total, 129 (77.2%) had AKI, while 38 had CKD. Regarding AKI, 83 children (64.3%) received HD only, 42 underwent PD only, while 4 underwent both HD and PD. Malaria AKI was treated with HD in 43 (51.8%) or PD in 8 (10.5%), while sepsis AKI was treated with HD in 20 (21.4%) or PD in 33 (78.6%). Mortality in AKI was 16.3% overall, 10.8% in children on HD only, and 26.2% in children on PD only. Patients with sepsis AKI had higher mortality compared to patients with malaria AKI (RR 7.96 [1.70-37.37]). Subgroup analysis showed that age, diagnosis, and dialysis modality were not independent risk factors for mortality. The aetiology of CKD was glomerulonephritis in 26 (68.4%): treatment was HD in 36 and PD in 2 with mortality being 26.3%. CONCLUSIONS PD for AKI showed relatively good outcomes in a LMIC. However, funding and support for a formal dialysis program for the management of AKI and CKD are needed.
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Affiliation(s)
- Adebowale D Ademola
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Ibadan, Nigeria
| | - Adanze O Asinobi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Ibadan, Nigeria
| | - Michael A Alao
- Department of Paediatrics, University College Hospital, Ibadan, Ibadan, Nigeria
| | - Andrew W Wade
- Division of Pediatric Nephrology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
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