Clinical Profile and Outcome of Pediatric Acute Kidney Injury in Cameroon: Comparison between an Urban and a Semi-Urban Health Facility

Abstract

Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban health facilities such as large university Teaching hospitals with a nephrology service. Objective: The aim of this study was to compare the epidemiology of pediatric AKI in urban and semi-urban health facility. Patients and method: We conducted a retrospective study of 16 months in a tertiary urban hospital (General Hospital of Douala) and a secondary semi-urban health facility (Region hospital of Buea). Diagnostic of AKI was done using usual criteria. Age, sex distribution, etiologies of AKI, access to dialysis, renal recovery at hospital discharge, at 1 and 3 months and patient survival at hospital discharge was compared. Results: A total of 31 patients were included (GD 17 and RHB 14). Boys were more prevalent in the semi-urban setting (86% Vs 47% p = 0.029). Median age was comparable in the both group although most semi-rural patient were older (6.5 Vs 10 years p = 0.093). Hospital acquired AKI was only found in urban setting and account for 40% of pediatric urban AKI. Malaria related AKI (mainly black water fever) and sepsis were the main etiologies of AKI in urban and semi-urban milieu. Dialysis access was the same but 30% of children could not access to it in urban setting compare to none in semi-urban area. Reasons of non-access to dialysis were lack of pediatric material and financial constraints. In Hospital mortality was the same but was more severe amount patient who could not receive dialysis. Among the survivor, CKD was only found in urban setting. Conclusion: Although mainly due to malaria, pediatric AKI differs from urban tertiary and semi-urban secondary health facility in Cameroon. Hospital acquired AKI is only found in urban setting where children are younger and less boys. AKI in urban setting seems to be more severe with less access to dialysis and more risks of CKD.