Acute kidney injury and kidney replacement therapy in pediatric severe trauma and burns patients, a single-center review from a middle-income country

INTRODUCTION: Limited information exists regarding acute kidney injury (AKI) and kidney replacement therapy (KRT) in pediatric trauma in South Africa. This study aims to summarize the management of AKI and KRT in the pediatric population (< 13 years) admitted to a level 1 Trauma and Burns intensive care unit between January 2018 and September 2023. MATERIALS AND METHODS: A retrospective chart review from the Trauma Registry at Inkosi Albert Luthuli Central Hospital in Durban, South Africa, examined demographics, mechanism of injury, injury severity score, management, outcome, and imaging. Patients with AKI were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) classification adapted for children. RESULTS: 51 (17.5%) of 291 patients were classified as having AKI. Ten patients were classified as stage 1 (19.6%), 15 as stage 2 (29.4%), and 26 as stage 3 (51%). Of these 51, only 9 (17.7%) patients were treated with KRT, with 1 survivor (11.1%). 24 patients were considered to have a poor prognosis and did not receive KRT (47.1%), while 18 (35.3%) patients recovered without the need for KRT. The average length of stay was 14 days. Six (66.7%) of the 9 KRT patients were diagnosed with AKI on day 1, and 1 (1.1%) patient each on day 2, day 4, and day 5. Overall renal recovery was 35.3% for all patients. CONCLUSION: In this South African pediatric cohort, most young children who presented with AKI in the post-trauma or burns group either recovered without KRT or died from multi-organ dysfunction. A small percentage required KRT, and of these, few survived.