Dr. Ibrahim Rasheed Olayinka

Background & objective: Despite available data from developed countries, suggesting a high incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID–19), there is scarce data from African countries, including Nigeria. We conducted this study to determine and document the incidence, the associated factors and the outcome (in–hospital mortality) of AKI among COVID–19 patients managed in a center in Nigeria. Methodology: It was a retrospective review of confirmed COVID–19 cases managed at a center in Nigeria. AKI was defined using 2012 Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. We extracted relevant data from the electronic records of the COVID–19 patients admitted to our hospital and analyzed. Fischer's exact tests were used to test factors associated with AKI for discrete variables, Mann–Whitney U test was used for skewed continuous data, and T–test for continuous normal distribution variables. Results: This study involved 41 of the 56 confirmed COVID–19 cases. The mean age was 45 ± 17.94 y. A majority of the patients were males (33; 80.5%). AKI occurred in 6 (14.6%) of the patients. Of the 6 AKI; 4 (66.7%) and 2 (33.3%) were in stages 1 and 3 respectively. One patient (16.7%) had had hemodialysis. Of the 6 with AKI, 3 died with a mortality rate of 50.0%. Factors associated with AKI included age above 45 years, body weakness, severe and critical COVID, urea > 10 mmol/l, and serum creatinine > 1.5 mg/dl. Only severe and critical disease was predictive of AKI (adjusted odds ratio 1.777, 95% CI 1.028, 3.074). Conclusion: The results of our study show that AKI is common in severe and critical COVID–19 and is associated with a poor outcome. Key words: Acute kidney injury; AKI; COVID–19; Mortality Abbreviations: AKI – Acute kidney injury; KDIGO – Kidney Disease: Improving Global Outcomes 2012; eGFR – estimated glomerular filtration rate; MDRD – Modification of Diet in Renal Disease           Ethical Review Committee Approval: MOH/ADM/SUB/1152/1/374 Citation: Ibrahim OR, Taofeek Oloyede T , Gbadamosi H , Musa Y , Aliu R , Bello SO , Alao MA , Suleiman MS , Adedoyin OT. Acute kidney injury in COVID–19: A single–center experience in Nigeria. Anaesth. pain intensive care 2021;25(4):470–477. DOI: 10.35975/apic.v25i4.1567

Background Despite the kidney being affected by diphtheria exotoxin, the extent of acute kidney injury (AKI) and its possible impact on outcomes remain unknown. This study examined the incidence, risk factors, and outcomes of AKI in children with diphtheria. Methods This was a prospective cohort study of confirmed diphtheria managed from July 1, 2023, to April 30, 2024, at a health facility in Nigeria. We obtained data on clinical and laboratory features and treatments received. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results We included 237 children with a median [interquartile range] age of 7.0 [4–10] years. Using KDIGO, 139 (58.6%) had AKI [stage 1:88 (37.1%); stage 2: 18 (7.6%); and stage 3: 33 (13.9%)]. Variables associated with AKI included age, sore throat, inability to swallow, difficulty breathing, nasal blockade, hypoxemia, nasal discharge, pallor, abnormal chest findings, hospitalization duration, vaccination status, white blood cells, lymphocytes, platelets, serum bicarbonate, sodium and potassium, and treatments received, p < 0.05. On multivariable logistic regression, predictors of AKI included age ≤ 60 months [AOR 2.75, 95% CI 1.27–5.95], dexamethasone [AOR 2.57, 95% CI 1.11–4.60], oxygen therapy [4.85, 95% CI 1.24–18.99], and ibuprofen [AOR 2.74, 95 CI% 1.16–6.44]. Mortality rate was 24.5% (58/237) and 33.1% (46/139) in AKI. The odds of deaths with AKI were 3.56 (95% CI 1.76–7.14). Conclusion There is a high incidence of AKI among children with diphtheria and increased odds of death. Factors that predicted AKI included younger age, oxygen therapy, and medications (ibuprofen and dexamethasone).

Background Estimated baseline serum creatinine (bSCr) affects the incidence and outcomes of childhood severe malaria. Herein, we estimated baseline serum creatinine (bSCr) levels of 541 children with severe malaria using Pottel and Scwartz formulas for AKI incidence, hospitalization outcomes, and evaluated risk factors for death. Methods This was a retrospective review of malaria cases from January 2019 to December 2020 at a tertiary health facility in northern Nigeria. We extracted relevant data from the electronic health record. AKI definition and staging was based on the 2012 Kidney Disease Improving Global Outcomes (KDIGO). Results: The estimated bSCr using Pottel’s method was lower with a mean (standard deviation) bias of -0.039 (0.013) mg/dl, an upper limit of agreement (-0.014 mg/dl), and the lower limit of agreement (-0.063 mg/dl). All (100%) of the estimated bSCr using Pottel’s method fell within 30% of the Schwartz method's estimated bSCr. The incidence of AKI from Pottel’s method was higher than the Schwartz’s method (43.3% vs. 38.4%, p < 0.001). The incidence of AKI derived from Pottel’s method was highest among those under 5 years old < 0.001). The mortality rate was 6.1% (33 deaths out of 541 admissions). Pottel’s method detected more deaths (57.6%; 19 out of 33) vs. Schwartz’s method (48.5%; 16 out of 33), < 0.001. Factors that were associated with malaria AKI death included acidosis with an adjusted odds ratio (AOR) of 9.2 (95% CI 1.671 to 50.097), the first 72 h [AOR 7.0 (95% CI 1.358, 35.840)], and KDIGO stage 3 of AKI [AOR 14.4 (95% CI 3.073, 66.969)]. Conclusion Among Nigerian children with severe malaria, bSCr back-calculated from Pottel’s equation showed a minimal bias, narrow limit of agreement, and high degree of accuracy. Also, Pottel’s method detected more AKI and deaths.

Acute kidney injury (AKI) is a common, life-threatening clinical complication of severe malaria in children associated with increased short- and long-term mortality. Malaria remains a leading cause of child mortality in Africa, where most severe malaria cases and deaths occur, and a few countries account for most of the global disease burden. While some children who develop severe malaria-associated AKI may require dialysis during hospitalization, survi- vors may require long-term care for chronic kidney disease, including maintenance dialysis and kidney transplant. There are variations in the availability and type of dialysis services offered across malaria-endemic African coun- tries with major barriers to accessing kidney transplants. Access remains challenging among countries with dialysis services because these centers are usually located in selected specialized urban hospitals far from most patients. The limited number of available pediatric nephrologists in the region further impacts the delivery of specialized nephrology care. This review provides an overview of the magnitude of malaria-associated AKI in selected malaria- endemic countries, country-specific perspectives on dialysis availability and access, and kidney transplant services availability for children who develop chronic kidney disease.