Incidence and risk predictors of acute kidney injury among HIV-positive patients presenting with sepsis in a low resource setting

Davis Kimweri,Winnie Muyindike,Rose Muhindo,Julian Ategeka,Faustine Ceasor,Edwin Nuwagira

doi:10.1186/s12882-021-02451-6

Abstract

BackgroundAcute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality. In our resource-limited setting (RLS), the most common cause of AKI is sepsis and volume depletion. Sepsis alone, accounts for up to 62 % of the AKI cases in HIV-positive patients.ObjectiveThe major goal of this study was to determine the incidence and risk predictors of AKI among HIV-infected patients admitted with sepsis at a tertiary hospital in Uganda.MethodsIn a prospective cohort study, we enrolled adult patients presenting with sepsis at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between March and July 2020. Sepsis was determined using the qSOFA criteria. Patients presenting with CKD or AKI were excluded. Sociodemographic characteristics, physical examination findings, and baseline laboratory values were recorded in a data collection tool. The serum creatinine and urea were done at admission (0-hour) and at the 48-hour mark to determine the presence of AKI. We performed crude and multivariable binomial regression to establish the factors that predicted developing AKI in the first 48 h of admission. Variables with a p < 0.01 in the adjusted analysis were considered as significant predictors of AKI.ResultsOut of 384 patients screened, 73 (19 %) met our inclusion criteria. Their median age was 38 (IQR 29–46) years and 44 (60.3 %) were male. The median CD4 T-cell count was 67 (IQR 35–200) cells, median MUAC was 23 (IQR 21–27) cm and 54 (74.0 %) participants were on a regimen containing Tenofovir Disoproxil Fumarate (TDF). The incidence of AKI in 48 h was 19.2 % and in the adjusted analysis, thrombocytopenia (Platelet count < 150) (adjusted risk ratio 8.21: 95 % CI: 2.0–33.8, p = 0.004) was an independent predictor of AKI.ConclusionsThere is a high incidence of AKI among HIV-positive patients admitted with sepsis in Uganda. Thrombocytopenia at admission may be a significant risk factor for developing AKI. The association of thrombocytopenia in sepsis and AKI needs to be investigated.

Highlights

Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality
There is a high incidence of AKI among HIV-positive patients admitted with sepsis in Uganda
We hypothesized that the incidence of AKI is higher in a population living with HIV presenting with sepsis than has been reported in studies that focus on either the incidence of AKI in HIV or in sepsis independently

Summary

Introduction

Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality. In our resource-limited setting (RLS), the most common cause of AKI is sepsis and volume depletion. Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and imposes a heavy burden of illness in terms of morbidity and mortality. In resource-limited settings (RLS), the most common causes of AKI include sepsis and volume depletion which account for 43 and 17 % respectively in HIV-negative patients and up to 62 and 20 % respectively in HIV-infected patients [2].

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