Breakdown of aetiologies of AKI, N = 126.

Background
Whilst malaria is a prominent aetiology associated with acute kidney injury (AKI) in many parts of Africa, a shift in the traditional AKI aetiologies has been witnessed in sections of the continent. Additionally, limited access to dialysis worsens patient outcomes in these low-resource settings. This retrospective cross-sectional study aimed to determine the associated aetiologies, predictors of need for dialysis and malaria-associated AKI (MAKI), and outcomes of AKI and dialysis among children evaluated by the renal service in Lusaka, Zambia.
Methods
The study sampled all children aged 16 years or below, diagnosed with AKI between 2017 and 2021, by the renal unit at the University Teaching Hospitals- Children’s Hospital (UTH-CH), and retrospectively abstracted their records for exposures and outcomes. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Frequency and percentage distributions were used to describe the occurrence of AKI aetiologies and treatment outcomes. Predictors of the need for dialysis, MAKI, and poor treatment outcome were identified by using multivariable logistic regression models.
Results
A total of 126 children diagnosed with AKI were included in this study. Malaria was the most frequent aetiology of AKI(61.1% (77/126, 95% Confidence Interval (CI): 52.0%-69.7%)). Of the 126 children with AKI, 74.6% (94) underwent dialysis. Predictors of the need for dialysis were oliguria (p = 0.0024; Odds ratio (OR) = 7.5, 95% CI: 2.1–27.7) and anuria (p = 0.0211; OR = 6.4, 95% CI = 1.3, 30.7). A fifth (18.3%, 23/126) of the children developed chronic kidney disease (CKD), 5.6% (7/126) died and, a year later, 77% (97/126) were lost to follow-up.
Conclusion
At UTH-CH, malaria is the most frequent aetiology among children with AKI undergoing dialysis and children from low-medium malaria incidence areas are at risk; a considerable proportion of children with AKI need dialysis and Tenchoff catheter use in AKI is advocated.

研究背景
疟疾是非洲许多地区急性肾损伤（acute kidney injury, AKI）的重要病因，但非洲部分地区的AKI传统病因谱已发生转变。此外，在这些资源匮乏的环境中，透析可及性不足进一步恶化了患者的预后。本回顾性横断面研究旨在明确赞比亚卢萨卡大学教学医院-儿童医院（University Teaching Hospitals- Children’s Hospital, UTH-CH）肾脏科接诊儿童的AKI相关病因、透析需求及疟疾相关性AKI（malaria-associated AKI, MAKI）的预测因素，以及AKI患儿的诊疗结局与透析预后。

研究方法
本研究纳入2017年至2021年间于UTH-CH肾脏科确诊为AKI的所有16岁及以下儿童，回顾性提取其病历记录以收集暴露因素与结局数据。AKI的诊断采用改善全球肾脏病预后组织（Kidney Disease Improving Global Outcomes, KDIGO）2012年版标准。采用频数与百分比分布描述AKI病因及治疗结局的发生情况。通过多因素logistic回归模型，识别透析需求、MAKI及不良治疗结局的预测因素。

研究结果
本研究共纳入126名确诊AKI的儿童。疟疾是AKI最常见的病因，占比61.1%（77/126，95%置信区间（confidence interval, CI）：52.0%~69.7%）。在126名AKI患儿中，74.6%（94名）接受了透析治疗。透析需求的预测因素为少尿（p=0.0024；比值比（Odds ratio, OR）=7.5，95%CI：2.1~27.7）与无尿（p=0.0211；OR=6.4，95%CI：1.3~30.7）。五分之一（18.3%，23/126）的患儿进展为慢性肾脏病（chronic kidney disease, CKD），5.6%（7/126）的患儿死亡，随访1年后，77%（97/126）的患儿失访。

研究结论
在UTH-CH，疟疾仍是接受透析的AKI患儿最常见的病因；疟疾中低发地区的儿童同样存在患病风险；相当比例的AKI患儿需要接受透析治疗，本研究提倡在AKI诊疗中使用Tenckhoff导管。