Abstract
Background: Continuous renal replacement therapy (CRRT)-requiring acute kidney injury (AKI) in critically ill adult patients frequently occurs in the intensive care unit and is associated with high morbidity and mortality. There is a paucity of epidemiological data regarding CRRT-requiring AKI in sub-Saharan Africa. Methods: We conducted a retrospective cohort study of all critically ill adult patients with CRRT-requiring AKI at Universitas Academic Hospital, Bloemfontein, during the period 1 July 2010 to 30 June 2014. The primary purpose was to determine the incidence of CRRT-requiring AKI. Secondary objectives were to record mortality, renal recovery and duration of CRRT. Results: The number of patients with CRRT-requiring AKI was 87 (1.1%) of the 7 709 patients admitted to the ICU over this 4-year period. Of these, 37 (43%) were HIV infected. The median age was 56 years (43 years in the HIV-infected versus 64 years in the HIV-uninfected group (P < 0.01). The majority of the HIV-infected patients were Black (89%). Metabolic acidosis together with pulmonary oedema and oliguria were the main indications for dialysis. The overall mortality was 31% with most of the deaths (82%) occurring in the HIV-positive patients. These patients had a mortality rate of 60% versus 10% among the uninfected (P < 0.01. Multivariate logistic regression identified female sex and HIV infection as independent predictors of mortality. The median duration of CRRT was 3 days and renal recovery occurred in 26% of patients. Conclusions: The incidence of CRRT-requiring AKI in critically ill adult patients at Universitas Academic Hospital was low. The overall mortality was relatively low when compared to that reported by others; however, it was relatively very high in the HIV-infected group.
Highlights
Continuous renal replacement therapy (CRRT) was introduced into the intensive care (ICU) setting as early as the 1980s [1]
CRRT-requiring AKI in critically ill adult patients frequently occurs in the ICU, and is associated with high morbidity and mortality [3]
Since there is a paucity of epidemiologic data regarding CRRT-requiring AKI in sub-Saharan Africa, we conducted a study to determine the incidence of critically ill patients with CRRT-requiring AKI in the ICU and report here on their mortality rate and rate of renal recovery
Summary
Continuous renal replacement therapy (CRRT) was introduced into the intensive care (ICU) setting as early as the 1980s [1] This was due to the need for effective renal replacement therapy (RRT) in patients who were often haemodynamically unstable and unable to tolerate intermittent modalities of dialysis. Since there is a paucity of epidemiologic data regarding CRRT-requiring AKI in sub-Saharan Africa, we conducted a study to determine the incidence of critically ill patients with CRRT-requiring AKI in the ICU and report here on their mortality rate and rate of renal recovery. Additional clinical data included surgical status, number of organ failures and APACHE II (Acute Physiology and Chronic Health Evaluation II) score, duration of CRRT, need for mechanical ventilation and assessment of survival and renal recovery up to 90 days after discharge from the ICU. The data analysis was performed using STATA version 13.1
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