POS-056 Pattern of kidney disease in medical admissions in Ghana – a single centre study

Abstract

Hitherto, chronic kidney disease (CKD) was almost always the diagnosis made by most clinicians when patients present with elevated serum creatinine in clinical settings in Ghana. The majority of studies in Ghana have therefore focused on CKD. There is anecdotal evidence that acute kidney injury (AKI) is mostly underdiagnosed in clinical settings. The proportion of patients reporting with AKI is currently unknown in hospital admissions in Ghana according to our knowledge. We therefore set out the describe the pattern of kidney disease in medical admissions in Ghana. We conducted a retrospective study of all medical admissions at the Komfo Anokye Teaching Hospital (KATH) from November 2018 to June 2018 with elevated serum creatinine and diagnosis of AKI or CKD. KATH is the second largest tertiary Hospital in Ghana with 1200 beds. We recorded the demography, clinical presentation and laboratory findings from the clinical notes of patients admitted through the emergency unit and on the medical wards. We compared patients diagnosed with AKI and CKD and also determined the predictors of mortality in multiple logistic regression. P value of less than 0.05 was considered statically significant. The study involved 748 patients with kidney disease in 4,765 medical admissions within the study period. Kidney diseases had a prevalence of 15.7% of all medical admissions at the Komfo Anokye Teaching Hospital. There were I86 (24.9%) patients with AKI and 562 (75.1%) patients with CKD. The most common cause of AKI was acute tubular necrosis (ATN) involving 138 (74.2%) cases followed by 43 (23.1%) with pre-renal AKI. Post renal (obstruction) AKI was found in 5 (2.7%) of cases. There were 189 (25.3%) patients seen and discharged at the Emergency unit and 559 (74.7%) were discharged from the medical wards. Renal replacement therapy was required in 306 (40.9%) of patients at a point in their management but only 43 (14.5%) were able to undergo haemodialysis on admission. In-patient mortality on admission was 341 (45.6%). In-patients mortality was 96 (51.3%) in patients with AKI as compared to 245 (43.7%) in patients with CKD (p=0.057). Mortality in those seen at the emergency unit was significantly higher than those discharged from the emergency 138 (73%) vs. 206 (36.9%), p<0.001. Mortality was associated with male sex (p<0.001), presence of pericardial rub (p=0.018), emergency unit discharges (p<0.001), low MCV (p=0.020) in a multiple logistic regression. Kidney diseases account for 15.7% of all medical admissions and AKI was found in 24.9% of patients with kidney disease. Kidney disease was associated with high mortality. Mortality was associated with pericardial rub, male sex, emergency unit admissions and low MCV.