Aspectos epidemiológicos da injúria renal aguda dialítica em pacientes pediátricos no Rio de Janeiro

Abstract

Acute Kidney Injury (AKI) is a potentially life-threatening condition, especially in patients at the extremes of life and when Renal Replacement Therapy (RRT) is required. Epidemiological studies worldwide report mortality between 11 and 63% in pediatric patients submitted to RRT. Among children who survive an episode of AKI, up to 60% may remain with some residual impair in renal function. The aim of this study was to describe the epidemiological aspects related to dialysis requiring AKI in patients aged 0 to 18 years in the state of Rio de Janeiro. A retrospective observational study was carried out from a secondary database containing data from 35,435 patient records of all age groups submitted to extracorporeal therapies in 135 hospitals in the city of Rio de Janeiro and metropolitan area. After applying the inclusion and exclusion criteria, 693 patients were selected for this study. Most of the patients were male (59.5%) and were aged less than 2 years (63%), with a mean age of 3 years and 9 months. The majority of the patients were attended in private hospitals (76.5%). Sixty-seven percent of the subjects had at least 1 comorbidity, and the presence of comorbidities was even more prevalent in neonates (88%). The main etiology for AKI was sepsis (58.4%), being the most frequent cause since 2002. The lethality found was 65.2%, being lower in patients over 12 years of age (50%). Factors associated with lethality were age and etiology. The highest age was confirmed as a protective factor for death (HR: 1.88 for death in neonates when compared to patients over 12 years of age). The etiologies most related to death were perinatal asphyxia followed by sepsis (HR: 5.28 for asphyxia and HR: 4.05 for sepsis when compared to primary kidney diseases). This study confirmed the high lethality associated with dialytic AKI in pediatric patients and brought important data about its main aspects, and may contribute to the planning of preventive measures aimed at improve the outcomes of this condition.