Prevalence, associated factors, and immediate outcomes of acute kidney injury in critically ill children in Tanzania.

backgroundAcute kidney injury (AKI) is a common cause of morbidity and mortality in critically ill children, yet data on its prevalence and associated factors in low-resource settings remain limited.

methodsA hospital-based cross-sectional study was conducted from March to June 2020 at Benjamin Mkapa Hospital and Dodoma Regional Referral Hospital. Critically ill children aged 1 month to 15 years were enrolled. AKI was defined using KDIGO criteria based on serum creatinine and urine output assessed with repeat measurements within the first seven days to ensure accurate classification. Multivariable Poisson regression identified factors associated with AKI, while Firth penalized logistic regression assessed predictors of in-hospital mortality.

resultsNinety-two children were enrolled; 53 (57.6%) met KDIGO criteria for AKI. Most cases (84.9%) were identified at admission. AKI severity was stage 1 in 53%, stage 2 in 17%, and stage 3 in 30%. Respiratory distress was associated with AKI (aPR 1.83; 95%CI 1.02-3.33; p = 0.045), though it likely reflected overall illness severity. In-hospital mortality was significantly higher among children with AKI (35.8%) compared to those without (7.7%). Severe dehydration independently predicted mortality (adjusted OR 4.29; 95%CI 1.0-18.4; p = 0.049). Children aged 13-59 months had lower odds of death compared with infants.

conclusionsAKI is highly prevalent among critically ill children in Dodoma and is associated with increased mortality. Dehydration and younger age are key predictors of death. Early recognition, prompt fluid management, and improved access to dialysis are essential to improve outcomes in resource-limited settings.