Community-Acquired Acute Kidney Injury in Pediatric Inpatients: A Call to Action

Acute kidney injury (AKI) remains a critical concern in pediatric healthcare, characterized by its sudden onset and potential for severe complications. Among its various forms, community-acquired AKI (CA-AKI) emerges as a particularly concerning subset, presenting at the time of hospitalization and often associated with significant morbidity and mortality risks. The burden of CA-AKI is especially pronounced in low to medium-income countries, necessitating immediate attention and targeted interventions to lower its impact on pediatric health.

Limited prospectively collected data exist on CA-AKI in children, especially from India. However, a recent study led by Ashish A. et al. offers valuable insights into the etiology and outcomes of CA-AKI. The researchers enrolled hospitalized children aged two months to 12 years, revealing a significant prevalence of CA-AKI among the study population. Notably, diarrheal illnesses with dehydration and sepsis emerged as primary causes of CA-AKI. The study also revealed a concerning mortality rate among children diagnosed with CA-AKI, with 11% of children dying during hospitalization. Furthermore, the requirement of inotropic support emerged as an independent predictor of mortality.

The researchers also noted that most discharged children experienced complete restoration of kidney function. However, in those with incomplete renal recovery, a subset of patients progressed to chronic kidney disease (CKD) and required dialysis.

The study confirms that CA-AKI poses a significant threat to the health and well-being of hospitalized children, with the potential for long-term complications such as CKD. Urgent Action is warranted to address the underlying causes of CA-AKI, improve early detection and intervention strategies, and enhance post-discharge monitoring to mitigate its adverse effects.

Ashish A, Kumar M, Mishra K. Etiology and Outcome of Community-Acquired Acute Kidney Injury in Pediatric Inpatients. Indian Pediatrics. 2023;60.