Outcomes of patients with acute kidney injury at Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: Acute kidney injury (AKI) is a global problem and a significant cause of morbidity and mortality. The incidence of AKI based on data from high income countries is about 1 in 5 admissions; 1 in 4 of those that develop AKI die from its complications. Developing countries assume the same incidence and outcome of AKI as the developed countries. Objective: To describe the clinical presentation and determine the 90-day outcomes of patients with AKI as seen at Moi Teaching and Referral Hospital (MTRH). Methods: A prospective cohort study was done on all consenting patients above 18 years with AKI in the MTRH medical, surgical and gynecology inpatient wards. This was from January to July 2018 and a total of 103 patients were recruited. Demographic data and the clinical characteristics were collected using a structured interviewer-administered questionnaire. Participants were then followed up for 90 days and assessed for need for dialysis, recovery, progress to chronic kidney disease (CKD) and mortality. Categorical variables such as gender, severity of AKI, need for dialysis and mortality were summarized using frequencies and the corresponding percentages. Continuous variables such as age and creatinine level were summarized using mean and the corresponding standard deviation or median and the corresponding inter quartile range (IQR). Results: The mean age of the participants was 46.7 (SD 18.3) years. Majority were males at 61 (60%). Most of the patients were in stage 3 disease at 65 (63%). The mean creatinine at admission and at 90 days were 817.2 and 169 μmol/l respectively. Main comorbidities were hypertension at 31 (36.9%) and human immunodeficiency virus (HIV) at 28 (33.3%). The causes of AKI were multifactorial, the most common being pre-renal with vomiting at 50 (48.5%) and sepsis at 31 (30%). Need for dialysis was at 31 (30%) with a mean time to dialysis of 3.7 days and an average of 3.8 sessions (IQR 1- 7). Median length of hospitalization was 9.5 days (IQR 7-17.5). Fifteen participants were lost to follow up. Complete recovery was observed in 29 (52.7%) of the participants while 8 (14.5%) had partial recovery and 18 (32.7%) progressed to end stage renal disease (ESRD). We had a 35 (34%) all-cause mortality with most deaths occurring in stage 3 disease. Conclusion: Gastrointestinal tract losses and sepsis were the commonest risk factors for AKI with hypertension and HIV being the main comorbidities among these patients. Most patients presenting at MTRH with AKI had severe disease. Majority of the patients recovered their renal functions but a significant number had partial recovery of renal functions. Mortality was high. Recommendation: Patients with diarrhea and vomiting as well as sepsis need to be identified and managed early before stage 3 AKI. Factors associated with late discovery of AKI need to be investigated and mitigated. Emphasis on a management plan for the patients with partial recovery that require long term follow up to prevent progression to ESRD.