Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi

Mwayi Mtekateka,Alison Craik,Fergus Hamilton,Zuze Kawale,Ulla Hemmilä,Gavin Dreyer,Rhys D R Evans,Hamish Dobbie,Christopher J Kirwan

doi:10.1186/s12882-017-0446-4

Abstract

BackgroundEpidemiological data on Acute Kidney Injury (AKI) from low-income countries is sparse. The aim of this study was to establish the incidence, severity, aetiology, and outcomes of community-acquired AKI in Malawi.MethodsWe conducted a prospective observational study of general medical admissions to a tertiary hospital in Blantyre between 27th April and 17th July 2015. All patients were screened on admission with a serum creatinine; those with creatinine above laboratory reference range were managed by the nephrology team. Hospital outcome was recorded in all patients.ResultsEight hundred ninety-two patients were included; 188 (21 · 1%) had kidney disease on admission, including 153 (17 · 2%) with AKI (median age 41 years; 58 · 8% HIV seropositive). 60 · 8% of AKI was stage 3. The primary causes of AKI were sepsis and hypovolaemia in 133 (86 · 9%) cases, most commonly gastroenteritis (n = 29; 19 · 0%) and tuberculosis (n = 18; 11 · 8%). AKI was multifactorial in 117 (76 · 5%) patients; nephrotoxins were implicated in 110 (71 · 9%). Inpatient mortality was 44 · 4% in patients with AKI and 13 · 9% if no kidney disease (p <0.0001). 63 · 2% of patients who recovered kidney function left hospital with persistent kidney injury.ConclusionAKI incidence is 17 · 2% in medical admissions in Malawi, the majority is severe, and AKI leads to significantly increased in-hospital mortality. The predominant causes are infection and toxin related, both potentially avoidable and treatable relatively simply. Effective interventions are urgently required to reduce preventable young deaths from AKI in this part of the world.

Highlights

Epidemiological data on Acute Kidney Injury (AKI) from low-income countries is sparse
Participants 943 patients were admitted under general medicine during the study period and 892 were enrolled (Fig. 1)
There were no significant differences in Acute Kidney Injury Network (AKIN) aetiological categories of AKI (Sepsis and hypoperfusion, Toxins, Obstruction and Parenchymal Kidney Disease [STOP]), AKI severity, mortality, length of stay or renal recovery between patients with Human immunodeficiency virus (HIV) and those without HIV or in whom HIV status was unknown

Summary

Introduction

Epidemiological data on Acute Kidney Injury (AKI) from low-income countries is sparse. AKI is predominantly hospital acquired, affecting up to 22% of adult patients during an inpatient stay [1, 2] It leads to adverse outcomes for individuals, even in its mildest forms, with mortality across all stages of AKI estimated at 21%, increasing with AKI severity [2, 3]. The greatest impact of AKI may be in the poorest parts of the world It is in these regions, where epidemiological data on AKI is most limited and where adverse outcomes from AKI may be preventable with relatively cheap and simple interventions [6, 7]

Objectives

Methods

Results

Discussion

Conclusion