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In Ontario, kidney transplants have risen by 4% annually in recent years. An understanding of how this will affect the future annual number of posttransplant follow-up visits informs how to organize and deliver care.We projected the required number of annual posttransplant follow-up nephrology visits to inform posttransplant care delivery.Population-based retrospective cohort study.Linked databases from Ontario, Canada (population 14 million).Incident kidney transplant recipients from years 2008 to 2013.Frequency, distance traveled, and current and projected visits for posttransplant follow-up.Assuming a graft survival of 13 years and using the mean number of posttransplant clinic visits in years 1, 2, and 3, we forecasted the number of clinic visits needed in the year 2027.Using data from 2443 recipients, the mean (SD) number of clinic visits per recipient was 14.0 (9.2) in the first year after transplant, and 3.9 (6.2) and 3.0 (5.3) in the second and third year, respectively. If transplant rates rise by 4% per year until 2027, the estimated annual visits number will increase from 30 622 to 43 948. The median (25th, 75th percentile) distance between transplant center and patient's home was 30 (13, 65) km. The median round-trip travel distance for these visits in the first year after transplantation was 603 km per recipient, and median driving cost was Can$344 (2017).Regarding patient expense, limitations include that distances traveled were calculated orthodromically, and we did not account for patient cost of follow-up beyond that of vehicular travel. Regarding follow-up projections, limitations include the assumption that graft life span will not change, follow-up patterns do not differ between donor kidney type, and we did not survey stakeholders as to their preferred method of follow-up.We quantified the increase in posttransplant visits when regional annual rates of transplantation rise. Strategies recognizing the burden of these visits may enhance patient-centered care, as it is unclear how some patients manage costs, nor how the current health care system will manage the demand.Au cours des dernières années, le nombre de transplantations rénales a augmenté de 4 % annuellement en Ontario. Comprendre l’impact qu’aura cette augmentation sur le nombre annuel de visites de suivi post-transplantation dans les années à venir permettra d’organiser et de prodiguer les soins aux patients.Prévoir le nombre de visites de suivi post-transplantation qui seront requises dans le futur, de façon à orienter la prestation des soins.Étude de cohorte rétrospective basée sur une population.Les bases de données couplées de l’Ontario, au Canada (population: 14 millions).Les receveurs d’une greffe rénale entre 2008 et 2013.La fréquence des visites post-transplantation, la distance à parcourir pour s’y rendre, de même que leur nombre actuel et projeté.Nous avons estimé le nombre de visites cliniques qui seront nécessaires en 2027 à partir d’une survie du greffon estimée à 13 ans et du nombre moyen de visites pour les années 1, 2 et 3 post-transplantation.À partir des données de 2 443 receveurs, nous avons établi le nombre moyen (ET) de visites cliniques par receveur à 14,0 (9,2) pour la première année post-transplantation, à 3,9 (6,2) pour l’an 2 et à 3,0 (5,3) pour l’an 3. Si le nombre de greffes poursuit sa croissance au rythme de 4 % par an jusqu’en 2027, on estime que le nombre annuel de visites passera de 30 622 à 43 948. La distance médiane (25Les distances parcourues par les patients n’ont été calculées que de manière orthodromique et seules les dépenses liées aux déplacements en voiture ont été employées pour calculer les coûts aux patients. Les prévisions pour 2027 sont établies en tenant compte d’une survie du greffon qui demeurera stable, d’un schéma de suivi qui ne différera pas selon le type de donneur et du fait que nous n’avons pas questionné les intervenants quant à leur méthode de suivi préférée.Nous avons quantifié la hausse du nombre de visites post-transplantation en fonction de l’augmentation des taux de greffes annuels régionaux. Des stratégies reconnaissant le fardeau imposé par ces visites ont le potentiel d’améliorer les soins axés sur les patients puisqu’on ignore comment certains patients gèrent les coûts associés et comment le système de santé gèrera la demande.

BackgroundThe epidemiology of acute kidney injury (AKI) in children in sub-Sahara Africa (SSA) is poorly described. The aim of this study was to establish the incidence, etiology, and outcomes of community-acquired AKI in pediatric admissions in Southern Malawi.MethodsWe conducted a prospective observational study of pediatric admissions to a tertiary hospital in Blantyre between 5 February and 30 April 2016. Children were screened for kidney disease on admission with measurement of serum creatinine and assessment of urine output. The clinical presentation, etiology, and management of children with AKI were documented.ResultsA total of 412 patients (median age 4 years, 52.6% male, and 7.5% human immunodeficiency virus [HIV] infected) were included in the study. Forty-five patients (10.9%) had AKI (Kidney Disease: Improving Global Outcomes [KDIGO] criteria), which was stage 3 in 16 (35.6%) patients. Sepsis and hypoperfusion, most commonly due to malaria ( n = 19; 42.2%), were the causes of AKI in 38 cases (84.4%). Three patients (6.7%) underwent peritoneal dialysis (PD) for AKI: 2 of them recovered kidney function, and the other one died. In-hospital mortality was 20.5% in AKI and 2.9% if no kidney disease was present ( p < 0.0001). Seventeen (47.2%) patients with kidney disease had persistent kidney injury on hospital discharge.ConclusionAcute kidney injury occurs in 10.9% of pediatric admissions in Malawi and is primarily due to infections, particularly malaria. Acute kidney injury results in significantly increased in-hospital mortality. Urgent interventions are required to eliminate preventable causes of death in this region.