Abstract
BackgroundTrauma is a common cause of acute kidney injury (AKI). Yet little data exist regarding trauma-related-AKI in low-resourced settings, where the majority of deaths from AKI and trauma occur. We prospectively evaluated epidemiology of AKI in hospitalized Malawian trauma patients.MethodsAKI was defined by creatinine-only Kidney Disease Improving Global Outcomes (KDIGO) criteria. Those with AKI were followed up 3–6 months later to determine persistent kidney abnormalities. We calculated univariate statistics with Wilcoxon rank sum tests, Fisher’s exact, and chi-square tests to compare those with and without AKI. Multivariate log-risk regression modelling was used to determine risk ratios (RR) and 95% confidence intervals (CI) for AKI development.ResultsOf 223 participants, 14.4% (n = 32) developed AKI. Most patients were young (median age 32) males (n = 193, 86.5%) involved in road traffic injuries (n = 120, 53.8%). After adjusting for confounders, those with severe anemia during their admission were 1.4 times (RR 1.4, 95% CI 1.1–1.8) more likely to develop AKI than those without. Overall mortality was 7.6% (n = 17), and those who developed AKI were more likely to die than those who did not (18.8% vs 5.6%, p-value = 0.02). Almost half of those with AKI (n = 32) either died (n = 6) or had persistent kidney dysfunction at follow-up (n = 8).ConclusionIn one of the few African studies on trauma-related AKI, we found a high incidence of AKI (14.4%) in Malawian trauma patients with associated poor outcomes. Given AKI’s association with increased mortality and potential ramifications on long-term morbidity, urgent attention is needed to improve AKI-related outcomes.
Highlights
Trauma is a common cause of acute kidney injury (AKI)
We developed a prospective cohort to evaluate the incidence at a tertiary-level trauma referral center in Malawi, and to determine if there were specific risk factors that contributed to AKI development
It is likely that our estimate of AKI is an underestimation of the true overall incidence of AKI in adult trauma patients in Malawi. To our knowledge, this is the first study in a low-income setting in sub-Saharan Africa that prospectively evaluated AKI in trauma patients
Summary
Trauma is a common cause of acute kidney injury (AKI). Little data exist regarding trauma-relatedAKI in low-resourced settings, where the majority of deaths from AKI and trauma occur. Acute kidney injury (AKI) is a hidden pandemic, a devastating complication known to increase morbidity and mortality in a variety of conditions [1,2,3]. Injuries cause major mortality and morbidity in Malawi; it is estimated that injuries cause 6.4% of all deaths in the nation [13]. This is approximately 1.4–4 times higher the percentage of deaths due to accidents throughout nations in the European Union [14]. No study has evaluated the incidence of trauma-related AKI in Malawian adults
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