Determinants of the Outcomes of Acute Kidney Injury in Neonates at the Paediatric Unit of Kenyatta National Hospital

Abstract

Background: Neonatal acute kidney injury (AKI) has become a significant health concern across the globe due to its rising incidence and association with adverse outcomes. AKI in neonates is often multifactorial and may result from prenatal, perinatal or postnatal insults as well as any combination thereof. However, there was dearth of local empirical data as to the predictors of outcomes of AKI among neonates, necessitating this study. Objective: To assess the determinants of the outcomes of acute kidney injury in neonates at the paediatric unit of Kenyatta National Hospital. Methods: A retrospective study design was applied. As such, a retrospective desk review of the medical records of neonates aged 1 - 28 days treated with AKI at Kenyatta National Hospital’s pediatric unit was carried out. A study sample of 141 neonates with AKI seen at Kenyatta National Hospital’s pediatric unit between 1st January and 31st December, 2021 was used. The study utilized secondary data based on the study objectives which was collected using a Data Abstraction Form. The study data was analyzed through descriptive statistics using the Statistical Package for Social Sciences (SPSS, version 25). Logistic regression analysis was utilized to analyze the association between the study variables at 5% significance level. Results were presented in tables and figures. Results: A total of 141 health records of neonates with acute kidney injury at KNH in 2021 were reviewed. From the results, 62.4% (n = 88) of the neonates lived following treatment while 37.6% (n = 53) died. The renal function related factors found to have a statistically significant association with outcomes of acute kidney injury in the neonates were serum creatinine (SCr) values (β = -1.792, p = .000) and urine output values (β = 1.720, p = .011). The treatment related factors found to be statistically associated with outcomes of AKI in the neonates were stage of the AKI (β = -1.014, p = .007); onset of AKI (β = 1.101, p = .022) and being mechanically ventilated (β = -3.788, p =.003). None of the neonate related variables was found to have a statistically significant association with outcomes of AKI in the neonates. Conclusion: Serum creatinine and urine output levels were the renal function factors associated with outcomes of AKI in the neonates. Similarly, stage of the AKI, onset of AKI and being under mechanical ventilation were the treatment related factors associated with outcomes of AKI in the neonates. Recommendation: Efforts are required on development of appropriate for policies, strategies and interventions aimed at reducing the burden of neonatal AKI and improving the outcomes of acute kidney injury in this highly vulnerable patient population