Aetiologies and Short-term Outcomes of Acute Kidney Injury in a Tertiary Centre in Southwest Nigeria (original) (raw)
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BACKGROUND: Acute kidney injury (AKI) has become a global health problem and is associated with increased morbidity, mortality and overall health expenditure. Information on the epidemiology and outcomes of AKI will help to audit practice and advocate for policies that will reduce this burden. This study determined aetiologies, short term outcomes and their predictors in AKI patients in a tertiary hospital in Southwest Nigeria. METHODS: This was an 18-month retrospective study that involved 91 patients with AKI. The socio-demographic information, aetiology, severity and the treatment given to patients were recorded. Outcomes and their predictors were determined using multivariate analysis. P value < 0.05 was taken as statistically significant. RESULTS: The mean age of the study population was 45.12 ±20.67 years. Common causes of AKI were sepsis in 50(54.9%), hypovolaemia in 23(25.3%), cardiac failure in 7(7.7%) and eclampsia in 6(6.6%). Fifty-seven (62.6%) presented with stage 3. Thirty-one (34.1%) had haemodialysis. Forty-eight (52.7%) had complete renal recovery, 35(38.5%) died and 3(3.3%) left against medical advice while five (5.5%) were referred to other hospitals. Stage 3 AKI (Adjusted odd ratio: 6.79, confidence interval: 1.21:38.04, p = 0.029) and age ≥ 65 years (Adjusted odd ratio: 4.14, confidence interval: 1.32-13.04, p = 0.015) were significant predictors of mortality in AKI patients.
ISRN Nephrology, 2013
Background. Acute kidney injury in adults is a common cause of hospitalization, associated with high morbidity and mortality especially in developing countries. In spite of RRT the in-hospital mortality rates remain high even in the developed countries. ough a proportion of our patients receive renal replacement therapy as part of their management, data on outcomes are sparse. Study Objective. To determine the clinical outcomes of dialysis-treated AKI in our hospital. Methods. A retrospective analysis of the clinical data of all adult AKI patients treated with haemodialysis at the University of Teaching Hospital during an interrupted sixyear period was conducted. Analysis was done using SPSS version 17.0. Results. 34 males and 28 females with mean age of 41.3 ± 18.5 years were studied. e leading causes of AKI were sepsis (22.7%), acute glomerulonephritis (20.5%), acute gastroenteritis (15.9%), and toxic nephropathies (11.4%) and presented with mean e-GFR of 14.7 ± 5.8 mls/min/1.73 m 2 . Of the 62 patients, 29 (46.8%) were discharged from the hospital, 27 (43.5%) died in hospital, while 6 (9.7%) absconded from treatment. Survivors had better Ri�e grade than those who died ( . 1). Conclusion. Hospital mortality rate of dialysis-treated AKI patients is high and the severity of renal damage at presentation may be an important factor.
Background : The burden of Acute Kidney injury in developing countries especially in Sub-Saharan Africa is enormous. The morbidity and mortality appears to be rising despite the availability of dialysis therapy in some parts of Africa. Objective: To determine the causes and the factors that influence outcome of acute kidney injury in hospitalized patients at the Design : This was a prospective study of patients with acute kidney injury admitted in UCTH, Calabar over a 12 month period from January 2014 to December 2014. Data was analysed using SPSS version 18. Results : A total of 1138 patients were admitted with 42 of them developing AKI giving an incidence rate of 3.6%. Eighteen (42.9%) of the participants were males while 24 (57.1%) were females. Age ranged from 11 to 81 years with a mean age of 44.2±17.32 years. The common causes of AKI were septicaemia 20 (47.6%), malignant phase hypertension 7 (16.7%) and hypovolaemia 4 (9.5%).Other causes accounted for the remaining 11 (26.1%). Thirty one (73.8%) had co-morbidities and hypertension 12 (38.7%) was the commonest co-morbid condition. For outcome, 29 (69.0%) of the patients were discharged home while 13 (31.0%) of them died in the hospital. Survivors had more dialysis sessions than those that died (P < 0.05). Conclusion : Septicaemia is the commonest cause of AKI in our centre. In-hospital mortality rate is high. The severity of AKI at presentation and lack of dialysis therapy are contributory factors.
International Journal of Nephrology and Renovascular Disease
Background: Acute kidney injury (AKI) is a common complication in hospitalized patients and a marker for poor patient outcomes. It is associated with a high risk of mortality and other short-and long-term adverse outcomes. We aim to assess the clinical profile and shortterm outcomes of acute kidney injury in adult patients admitted to the medical ward. Methods: A hospital-based prospective observational study was conducted from October 2019 to January 2020. All adult patients diagnosed as AKI using kidney disease improving global outcomes (KIDGO) criteria were included in the study and prospectively followed to document the short-term outcomes. Outcomes and their predictors were determined using multivariate logistic regression. P-value less than 0.05 was taken as statistically significant. Results: A total of 160 patients were included in the study. Out of this, 96 (60%) were males, 118 (74%) had community-acquired AKI, and 51 (32%) had stage 3 AKI. Common causes of AKI were hypovolemia 62 (39%) and sepsis 35 (22%). Hypertension 69 (43%) and heart failure 50 (31%) were common underlying comorbidities. Fifty-six (35%) patients developed systemic complications, 98 (61.2%) had persistent AKI, 136 (85%) had prolonged length of hospital stay, and 18 (11%) were readmitted to the hospital. The presence of AKI-related complication (AOR=2.7, 95% CI: 1.14-6.58, p=0.024), and duration of AKI (AOR=9.7, 95% CI: 2.56-36.98, p=0.001) were factors associated with prolonged length of hospital stay. Preexisting CKD (AOR=3.6, 95% CI: 1.02-13.14, p=0.035) and stage 3 AKI (AOR=2.1, 95% CI: 1.6-3.57, p=0.04) were factors associated with 30-day hospital readmission. Conclusion: Hypovolemia and infections were the primary causes of AKI. Complications, prolonged length of hospital stay, persistent AKI, and rehospitalization were poor short-term outcomes of AKI. Early diagnosis and timely management of AKI particularly in high-risk hospitalized patients, and post-AKI care including management of comorbidities for AKI survivors should improve these poor short-term outcomes.
Acute kidney injury in Lagos: Pattern, outcomes, and predictors of in-hospital mortality
Nigerian Journal of Clinical Practice, 2017
Context: The pattern of acute kidney injury (AKI) differs significantly between developed and developing countries. Aims: The aim of th study was to determine the pattern and clinical outcomes of AKI in Lagos, Southwest Nigeria. Settings and Design: A retrospective review of hospital records of all patients with a diagnosis of AKI over a 20-month period. Subjects and Methods: Records of 54 patients were reviewed. Information retrieved included, bio-data, etiology of AKI, results of laboratory investigations, and patient outcomes. Statistical Analysis Used: Continuous data are presented as means while categorical data are presented as proportions. The Student's t-test was used to compare means while Chi-square test was used to compare percentages. Logistic regression analysis was used to determine the factors that predicted in-hospital mortality. Results: Twenty-seven (50%) of the patients were male. The mean age of the study population was 39.7 years ± 16.3 years. Sepsis was the etiology of AKI in 52.1% of cases. Overall, in-hospital mortality was 29.6%. Patients who died had a shorter mean duration of hospital stay (9.2 days vs. 33.9 days [P < 0.01]), lower mean serum bicarbonate (19.5 mmol/L vs. 22.9 mmmol/L [P = 0.02]), were more likely to be admitted unconscious (82.4% vs. 17.6% [P = 0.01]) and to have been admitted to the Intensive Care Unit (37.5% vs. 7.9% [P = 0.01]). In addition, when dialysis was indicated, patients who did not have dialysis were more likely to die (58.3% vs. 41.7% [P = 0.02]). Conclusions: The pattern of AKI in this study is similar to that from other developing countries. In-hospital mortality remains high although most of the causes are preventable.
Brazilian Journal of Nephrology, 2020
Introduction: Acute kidney injury (AKI) is a recurrent complication in the intensive care unit (ICU) and is associated with negative outcomes. Objective: To investigate factors associated with mortality in critically ill AKI patients in a South Brazilian ICU. Methods: The study was observational retrospective involving AKI patients admitted to the ICU between January 2011 and December 2016 of at least 18 years old upon admission and who remained in the ICU at least 48 hours. Comparisons between selected characteristics of survivor and non-survivor groups were done using univariate analysis; multivariate logistic regression was applied to determine factors associated with patient mortality. Results: Of 838 eligible patients, 613 participated in the study. Men represented the majority (61.2%) of the patients, the median age was 53 years, and the global mortality rate was 39.6% (n= 243). Non-recovery of renal function after AKI (OR= 92.7 [38.43 - 223.62]; p <0.001), major surgery-as...
Pan African Medical Journal, 2017
Introduction: Little is known about the pattern and outcome of Acute Kidney injury (AKI) in Sudan. This study aimed to determine the etiology and outcome of AKI among Sudanese adults. Methods: A retrospective cohort study was conducted in a tertiary level hospital, Soba University Hospital, Sudan. The medical records of all adults admitted to hospital from the 1 st of January to 31 st of December 2014 were reviewed. The diagnosis and severity of AKI was defined as per the Kidney Disease Improving Global Outcomes (KDIGO) recommendations. Results: The medical records of 6769 patients were reviewed. AKI was diagnosed in 384 patients (5.7%); being community acquired in 82.6% of cases. Sepsis, volume depletion, obstructive uropathy, heart failure, acute glomerulonephritis and severe malaria were the commonest causes of AKI diagnosed in 44%, 38.5%, 8.9%, 5.7%, 4.7% and 3.1% of patients, respectively. Following treatment complete renal recovery was seen in 35.7% of patients; whereas 31.2% of patients died. Predictors of increased risk of death were old age [OR 1.03, 95% CI (1.01-1.057); P=0.003], presence of chronic liver disease [OR 2.877, 95% CI (1.5-5.5); P=0.001], sepsis [OR 2.51, 95% CI (1.912-4.493);P=0.002] and the severity of AKI [OR 3.873, 95% CI(1.498-10.013);P=0.005]. Conclusion: AKI was diagnosed in 5.7% of adults admitted to hospital. Most patients were having community acquired AKI. Old age, the presence of chronic liver disease, sepsis, and the severity of AKI as per KDIQO staging were significant predictors of mortality.
Clinical Spectrum and Outcome of Patients With Acute Kidney Injury
Background: The incidence of acute kidney injury (AKI) has increased in recent years, both in the community and in hospital settings.In India, it is the most common renal emergency and as many as 1.5 percent of hospital admissions are referred to nephrology service for AKI. Results: Out of the 152 patients with AKI, 96 (60.5%) were male and 56 (39.5%) were female with a male to female ratio of 1.7:1. The age of the patients ranged from 18 to 76 years with a mean age of 44.68±13.13 years, the median age of the study population was 46 years.71 patients (46.7%) had associated co-morbidities of which diabetes mellitus and chronic liver disease were the commonest, the rest 81 patients (53.3%) did not have any co-morbidities. Fever (25.0%)was the most common presenting symptom followed by oliguria (21.7%) and pain abdomen (17.8%), acute tubular necrosis (61.9%) due to sepsis was the most common aetiology of AKI. Patients with community acquired AKI (CA-AKI) required renal replacement therapy (RRT), 51.5% more than patients with hospital acquired AKI (HA-AKI) and it was found to be statistically significant (p=0.005).The mean duration of hospital stay was 8.03±3.74 in patients with CA-AKI and 8.63±4.37 in patients with HA-AKI. The overall outcome was better in patients with CA-AKI showing full recovery in 73.3% and partial recovery in 77.5% of the patients, and this was found to be statistically significant (p=0.02) Conclusion: AKI was more common in the middle-aged group who had associated medical co-morbidities which predisposed them toAKI. Sepsis was the commonest cause of AKI leading to majority of patients presenting with feverand developing AKI in the community or during the course of hospital stay. Community acquired AKI had ashorter duration of hospitalization and an overall better outcome than hospital acquired AKI Key Word: Acute kidney Injury (AKI), community acquired AKI,hospital acquired AKI (HA-AKI, renal replacement therapy (RRT).
2016
Copyright © 2013 Pedro Chimezie Emem-Chioma et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Acute kidney injury in adults is a common cause of hospitalization, associated with high morbidity and mortality especially in developing countries. In spite of RRT the in-hospital mortality rates remain high even in the developed countries. ough a proportion of our patients receive renal replacement therapy as part of their management, data on outcomes are sparse. Study Objective. To determine the clinical outcomes of dialysis-treated AKI in our hospital.Methods.A retrospective analysis of the clinical data of all adult AKI patients treated with haemodialysis at the University of Teaching Hospital during an interrupted six-year periodwas conducted. Analysis was done using SPSS version 17.0.Results. 34males and ...
Anwer Khan Modern Medical College Journal, 2023
Background and objectives: AKI is an increasingly common complication of critical illness, with some researches showing that as high as 1 in 5 adults and 1 in 3 children experiencing AKI per hospital admission. Whether occurring in the community or in the hospital, the clinical and public health importance of AKI is well established due to the association with high mortality and its separate independent effect on the risk of death and resource use. This study was aimed to find out the etiology and outcome of acute kidney injury patients requiring haemodialysis. Methods: A retrospective study was done on 70 patients of AKI who required haemodialysis support in dialysis unit of medicine department of Jahurul Islam Medical College Hospital, Kishoreganj during the time period from Jan-2018 to Dec-2020. All patients of age 13 and above with AKI and have been dialyzed at least once during the study period were included. Results: In this study, there was an overall male preponderance (70%) with age range of 13-40 years (48.57%). Most common features of presentation were oliguria, cough, respiratory distress, drowsiness, disorientation, reddish urine, pedal edema, fever and high blood pressure. The most common causes of AKI were sepsis (30%), hypovolemia (21.42%), acute glomerulonephritis (AGN) (14.29%) and pregnancy related causes (10%). Common indications for haemodialysis of AKI patients were refractory fluid overload (70%), features of uraemic encephalopathy (22.86%). In this study, 78.57% of AKI patients requiring haemodialysis were improved and discharged, 08.57% patients were progressed to end stage renal disease, 07.15% patients were expired and 05.71% patients were absconded. Conclusion: It is concluded that sepsis, hypovolemia, AGN, obstetric causes, surgical causes and nephrotoxins were the primary causes of AKI patients requiring haemodialysis in this study. Most of these causes can be prevented with simple interventions such as appropriate management of infections, health education on oral rehydration, quality prenatal and emergency obstetric care and taking appropriate precautions when prescribing potentially nephrotoxic medications. Majority of the patients of AKI with complications were improved with haemodialysis. So, expansion of haemodialysis services to all parts of the country is necessary.