Acute kidney injury: incidence, risk factors, and early outcomes in hospitalized children with sickle cell disease attending a tertiary hospital in Eastern Uganda.

BACKGROUND

Many sickle cell disease (SCD) patients experience renal damage that impairs function, with acute kidney injury (AKI) significantly affecting both immediate and long-term outcomes. The only Ugandan study on this subject reported a high incidence and mortality of AKI among children with SCD, but did not assess other outcomes.

METHODS

This hospital-based prospective study was conducted between January and June 2024 at Jinja Regional Referral. AKI was diagnosed using KDIGO criteria, and participants were followed until discharge or death. Outcomes included length of hospital stay, mortality, and referral. Data were analyzed using SPSS v26, with Modified Poisson regression to identify significant risk factors (P < 0.05).

RESULTS

A total of 117 children were enrolled, slightly more females (52.1%) than males. Most were under 10 years, with 40.2% below 5 years and 42.7% aged 5–9 years? AKI occurred in 30 children, an incidence proportion of 25.6%. Independent risk factors for AKI included older age (aRR = 1.416), not using hydroxyurea (aRR = 1.628), frequent Nonsteroidal Anti Inflammatory Drugs (aRR = 1.186) use for pain, presence of other illnesses (aRR = 1.995), more than one transfusion in the preceding 6 months (aRR = 1.540), and stunting (aRR = 1.204) (P < 0.05 for all). Overall mortality was 5.1% (6/117), all occurring in children with AKI, giving a mortality of 20% in this group (P < 0.001). Prolonged hospital stay was significantly more common in the AKI group (54.5% vs. 13.8%, P < 0.001).

CONCLUSIONS

The incidence of AKI was high, affecting one quarter of participants. Routine AKI screening is recommended for all SCD admissions. Ensuring hydroxyurea availability, educating patients on safe analgesic use, and close monitoring of SCD children with AKI could reduce mortality.