Clinical Profile and Outcome of Acute Kidney Injury in Elderly Adults in a Tertiary Hospital in Cameroon

Abstract

Background: Elderly patients have a high risk of acute Kidney Injury (AKI) due to aging, decreased renal function and the presence of comorbidities. There is limited data on AKI in elderly patients in low income regions, especially in Sub-Saharan Africa. We therefore sought to describe the clinical profile and outcome of AKI in elderly in a tertiary hospital in Cameroon. Methods and Materials: We reviewed the medical records of all patients admitted with the diagnosis of AKI in the internal medicine unit of the Yaounde University Teaching Hospital, from January 2015 to February 2018. Records of elderly patients (≥65 years) were retrieved and analysed. AKI was diagnosed and classified using the KDIGO (Kidney Disease Improving Global Outcomes) 2012 classification. The diagnosis, aetiologies and mechanisms of AKI were clinical. Renal outcomes were evaluated on day 7, 14, 28, 60 and 90 of hospital stay. Results: We included 76 elderly (66% males) patients with a median [interquartile rate—IQR] age of 69 [65 - 75] years. Hypertension (60.5%), diabetes mellitus (36.8%) and heart failure (26.3%) were the most common comorbidities. The median [IQR] Charlson index was 4 [3 - 5]. Infections (47.4%) and hypovolemia (69.7%) were the most frequent risk factors for AKI. AKI was mainly community acquired (89.5%) and most of the patients were in stage 2 (34.2%) or 3 (29%). Pre-renal AKI (58%) was the leading mechanism involved. Hypovolemia and sepsis were the most common aetiologies. Of the 14.5% with indication for dialysis, only 2.6% had access to it. The overall prognosis was good with a mortality rate of 2.6%, complete and partial renal recovery at 3 months of 70%, and 26.3% respectively. Conclusion: AKI in the elderly, in our setting was community-acquired and affected mainly those with comorbidities. Pre-renal AKI was the main mechanism; hypovolemia and sepsis were the major aetiologies. Most participants had complete renal recovery at 3 months.