Introduction The incidence of acute kidney injury (AKI) is highest in low- and middle-income countries despite the International Society of Nephrology 0 by 2025 initiative. Critically ill patients are at increased risk for developing AKI, chronic kidney disease (CKD), end stage renal disease, and death. Methodology A prospective observational study was conducted among critically ill patients attending tertiary hospitals in Dodoma between October 2023 and May 2024. At baseline, patients’ demographic and clinical data were collected and laboratory investigations were performed to evaluate AKI. Patients were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria at baseline, 48 h, and on the seventh day, and eGFR was calculated after 3 months using the Chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Statistical analyses were conducted with SPSS (version 27). Logistic regression analyses were used to identify factors associated with AKI among critically ill patients, and Cox proportional hazard was used to determine predictors of mortality. Results A total of 303 critically ill patients were enrolled in the study with a median age of 45 (interquartile range [IQR] 32–65) years, and 54.8% were male. On admission, the median serum creatinine was 101 (89–155) μmol/L and the median hemoglobin was 13 (9–14) g/dL. The incidence of AKI among critically ill patients was 49.5% (150/303). Factors associated with AKI included: heart failure (odds ratio [OR] 5.3, 95% confidence interval [CI] [1.34–21.1], P = 0.018), use of local herbs (OR 4.7, 95% CI [1.53–14.33], P = 0.007), malignancy (OR 4.5, 95% CI [1.53–13.0], P = 0.006), obstetric complications (OR 3.69, 95% CI [1.25–10.88], P = 0.018), illness severity (OR 2.57, 95% [CI 1.30–5.06], P = 0.006), and sepsis (OR 2.56, 95% [CI 1.18–5.55] P = 0.018). Patients with AKI had longer mean hospital stays as compared with those without AKI (P < 0.01), 10% (15/150) developed CKD, and 46.7% (70/150) died. Predictors of mortality were age (hazard ratio [HR] 2.1, 95% CI [1.25–3.5], P = 0.005) and AKI (HR 1.82, 95% [CI 1.16–2.87], P = 0.01). Conclusions The incidence of AKI and its associated mortality is high among adult patients admitted with critical illness in our settings. Use of local herbs, heart failure, and severity of illness, malignancy, obstetric complications, and sepsis were found to be strongly associated with AKI. Patients with AKI had longer mean hospital stays and almost half of the patients with AKI died during hospitalization.

Acute kidney injury among adult patients admitted with critical illness in tertiary hospitals in Dodoma

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2026年7月7日

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Titus John Danda,
Emmanuel Sindato,
Alfred Meremo

摘要

Introduction

The incidence of acute kidney injury (AKI) is highest in low- and middle-income countries despite the International Society of Nephrology 0 by 2025 initiative. Critically ill patients are at increased risk for developing AKI, chronic kidney disease (CKD), end stage renal disease, and death.

Methodology

A prospective observational study was conducted among critically ill patients attending tertiary hospitals in Dodoma between October 2023 and May 2024. At baseline, patients’ demographic and clinical data were collected and laboratory investigations were performed to evaluate AKI. Patients were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria at baseline, 48 h, and on the seventh day, and eGFR was calculated after 3 months using the Chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Statistical analyses were conducted with SPSS (version 27). Logistic regression analyses were used to identify factors associated with AKI among critically ill patients, and Cox proportional hazard was used to determine predictors of mortality.

Results

A total of 303 critically ill patients were enrolled in the study with a median age of 45 (interquartile range [IQR] 32–65) years, and 54.8% were male. On admission, the median serum creatinine was 101 (89–155) μmol/L and the median hemoglobin was 13 (9–14) g/dL. The incidence of AKI among critically ill patients was 49.5% (150/303). Factors associated with AKI included: heart failure (odds ratio [OR] 5.3, 95% confidence interval [CI] [1.34–21.1], P = 0.018), use of local herbs (OR 4.7, 95% CI [1.53–14.33], P = 0.007), malignancy (OR 4.5, 95% CI [1.53–13.0], P = 0.006), obstetric complications (OR 3.69, 95% CI [1.25–10.88], P = 0.018), illness severity (OR 2.57, 95% [CI 1.30–5.06], P = 0.006), and sepsis (OR 2.56, 95% [CI 1.18–5.55] P = 0.018). Patients with AKI had longer mean hospital stays as compared with those without AKI (P < 0.01), 10% (15/150) developed CKD, and 46.7% (70/150) died. Predictors of mortality were age (hazard ratio [HR] 2.1, 95% CI [1.25–3.5], P = 0.005) and AKI (HR 1.82, 95% [CI 1.16–2.87], P = 0.01).

Conclusions

The incidence of AKI and its associated mortality is high among adult patients admitted with critical illness in our settings. Use of local herbs, heart failure, and severity of illness, malignancy, obstetric complications, and sepsis were found to be strongly associated with AKI. Patients with AKI had longer mean hospital stays and almost half of the patients with AKI died during hospitalization.