Burden of acute kidney injury and associated factors among neonates admitted to the newborn unit, Moi Teaching and Referral Hospital – Eldoret Kenya.

Abstract

Background: Acute Kidney Injury (AKI) is the sudden deterioration in kidney function leading to inability to maintain fluid and electrolyte balance. The immature neonatal kidney is vulnerable to insult due to its reduced renal blood flow, high renal vascular resistance, and poor auto-regulation capacity thus compromising its efficiency. The incidence of AKI in neonatal intensive care units is estimated at 8% to 24% with a mortality rate of between (10-61%). Studying the burden of AKI and factors associated with it, will aid in formulation of standards of care and thereby reduce mortality and morbidity. Objectives: To determine prevalence, describe associated factors and outcomes of acute kidney injury among neonates in the newborn unit at Moi Teaching and Referral Hospital (MTRH). Methods: A prospective descriptive study was carried out at the new born unit of MTRH from October 2017 to March 2018. Systematic sampling technique was used. Data on the socio-demographic and clinical characteristics of 280 neonates surviving 48 hours of life was collected. Associated factors studied included gender, sepsis, 5 minute APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score, prematurity, birth weight, gestational age, respiratory distress, and exposure to nephrotoxic drugs. Blood samples were obtained on the day of recruitment and subsequent samples were taken after 7 days or earlier if there were clinical indications. Analysis of serum creatinine was done using the Jaffe method. Cases of AKI identified were classified using the neonatal Kidney Disease: Improving Global Outcomes (KDIGO) classification based on serum creatinine. Follow up was done until death, discharge or 28 days of life whichever came earlier. Chi-square and Fisher‟s exact test were used to test association of categorical variables while Wilcoxon Rank Sum test was used to compare initial serum creatinine between the two groups; all analysis was at 95% CI. Results: A total of 280 neonates were recruited with a male to female ratio of 1:1.1. The prevalence of AKI was 55(19.8%). The majority were in stage 3 at 38(69.1%) while stage 1 and 2 had 13(23.6%) and 4(7.3%) respectively. Clinical and socio-demographic factors had no statistically significant associations with AKI. Amongst those discharged before 28 days, there was no statistically significant difference in the length of stay between those with and those without AKI. Among those with AKI 19(34.6%) died; AKI was associated with a fourfold increased mortality ((OR 3.999; 95% CI 2.006, 7.973; p=0.000)). None of the neonates with AKI underwent renal replacement therapy. Conclusion: One in five neonates had Acute kidney injury. Having Acute kidney injury was associated with a four fold increased odds of mortality. There were no statistically significant associations with socio-demographic and clinical factors. Recommendations: Higher index of suspicion for AKI in neonates and initiation of appropriate management to reduce mortality.