Abstract：
BACKGROUND: Pediatric acute kidney injury (AKI) is a global health concern with an associated mortality risk disproportionately pronounced in resource-limited settings. There is a pertinent need to understand the epidemiology of pediatric AKI in vulnerable populations. Here, we proposed a prospective study to investigate the epidemiology and associated risk factors of \"severe dialysis dependent AKI\" in children among South Asian nations which would be the first and largest of its kind.
METHODS: The ASPIRE study (part of PCRRT-ICONIC Foundation initiative) is a multi-center, prospective observational study conducted in South Asian countries. All children and adolescents ≤ 18 years of age who required dialysis for AKI in any of the collaborating medical centers were enrolled. Data collection was performed until one of the following endpoints was observed: (1) discharge, (2) death, and (3) discharge against medical advice.
RESULTS: From 2019 to 2022, a total of 308 children with severe AKI were enrolled. The mean age was 6.17 years (63% males). Secondary AKI was more prevalent than primary AKI (67.2%), which predominantly occurred due to infections, dehydration, and nephrotoxins. Common causes of primary AKI were glomerulonephritis, hemolytic uremic syndrome, lupus nephritis, and obstructive uropathy. Shock, need for ventilation, and coagulopathy were commonly seen in children with severe AKI who needed dialysis. The foremost kidney replacement therapy used was peritoneal dialysis (60.7%). The mortality rate was 32.1%.
CONCLUSIONS: Common causes of AKI in children in South Asia are preventable. Mortality is high among these children suffering from \"severe dialysis dependent AKI.\" Targeted interventions to prevent and identify AKI early and initiate supportive care in less-resourced nations are needed.
METHODS: The ASPIRE study (part of PCRRT-ICONIC Foundation initiative) is a multi-center, prospective observational study conducted in South Asian countries. All children and adolescents ≤ 18 years of age who required dialysis for AKI in any of the collaborating medical centers were enrolled. Data collection was performed until one of the following endpoints was observed: (1) discharge, (2) death, and (3) discharge against medical advice.
RESULTS: From 2019 to 2022, a total of 308 children with severe AKI were enrolled. The mean age was 6.17 years (63% males). Secondary AKI was more prevalent than primary AKI (67.2%), which predominantly occurred due to infections, dehydration, and nephrotoxins. Common causes of primary AKI were glomerulonephritis, hemolytic uremic syndrome, lupus nephritis, and obstructive uropathy. Shock, need for ventilation, and coagulopathy were commonly seen in children with severe AKI who needed dialysis. The foremost kidney replacement therapy used was peritoneal dialysis (60.7%). The mortality rate was 32.1%.
CONCLUSIONS: Common causes of AKI in children in South Asia are preventable. Mortality is high among these children suffering from \"severe dialysis dependent AKI.\" Targeted interventions to prevent and identify AKI early and initiate supportive care in less-resourced nations are needed.
摘要：
背景：小儿急性肾损伤(AKI)是一个全球性健康问题，在资源有限的环境中，其相关死亡风险不成比例地显著。有必要了解脆弱人群中小儿AKI的流行病学。这里,我们提出了一项前瞻性研究,调查南亚国家儿童"严重透析依赖性AKI"的流行病学和相关危险因素,这将是同类研究中首例也是最大规模的.
方法：ASPIRE研究（PCRRT-ICONICFoundation计划的一部分）是一个多中心，在南亚国家进行的前瞻性观察研究。所有需要在任何合作医疗中心进行AKI透析的≤18岁儿童和青少年均被纳入。进行数据收集，直到观察到以下终点之一：（1）放电，(2)死亡,(3)违背医嘱出院。
结果：从2019年到2022年，共有308名患有严重AKI的儿童入组。平均年龄为6.17岁（63%为男性）。继发性AKI比原发性AKI更普遍（67.2%），主要是由于感染，脱水,和肾毒素。原发性AKI的常见原因是肾小球肾炎，溶血性尿毒综合征,狼疮性肾炎,和梗阻性尿路病.震惊,需要通风,凝血病常见于需要透析的重度AKI患儿.最主要的肾脏替代疗法是腹膜透析（60.7％）。死亡率为32.1%。
结论：南亚儿童AKI的常见原因是可以预防的。这些患有严重透析依赖性AKI的儿童死亡率很高。“需要有针对性的干预措施来早期预防和识别AKI，并在资源较少的国家启动支持性护理。
方法：ASPIRE研究（PCRRT-ICONICFoundation计划的一部分）是一个多中心，在南亚国家进行的前瞻性观察研究。所有需要在任何合作医疗中心进行AKI透析的≤18岁儿童和青少年均被纳入。进行数据收集，直到观察到以下终点之一：（1）放电，(2)死亡,(3)违背医嘱出院。
结果：从2019年到2022年，共有308名患有严重AKI的儿童入组。平均年龄为6.17岁（63%为男性）。继发性AKI比原发性AKI更普遍（67.2%），主要是由于感染，脱水,和肾毒素。原发性AKI的常见原因是肾小球肾炎，溶血性尿毒综合征,狼疮性肾炎,和梗阻性尿路病.震惊,需要通风,凝血病常见于需要透析的重度AKI患儿.最主要的肾脏替代疗法是腹膜透析（60.7％）。死亡率为32.1%。
结论：南亚儿童AKI的常见原因是可以预防的。这些患有严重透析依赖性AKI的儿童死亡率很高。“需要有针对性的干预措施来早期预防和识别AKI，并在资源较少的国家启动支持性护理。
