Abstract
BackgroundThere is a marked paucity of data concerning AKI in Sub-Saharan Africa, where there is a substantial burden of trauma and HIV.MethodsProspective data was collected on all patients admitted to a multi-disciplinary ICU in South Africa during 2017. Development of AKI (before or during ICU admission) was recorded and renal recovery 90 days after ICU discharge was determined.ResultsOf 849 admissions, the mean age was 42.5 years and mean SAPS 3 score was 48.1. Comorbidities included hypertension (30.5%), HIV (32.6%), diabetes (13.3%), CKD (7.8%) and active tuberculosis (6.2%). The most common reason for admission was trauma (26%). AKI developed in 497 (58.5%). Male gender, illness severity, length of stay, vasopressor drugs and sepsis were independently associated with AKI. AKI was associated with a higher in-hospital mortality rate of 31.8% vs 7.23% in those without AKI. Age, active tuberculosis, higher SAPS 3 score, mechanical ventilation, vasopressor support and sepsis were associated with an increased adjusted odds ratio for death. HIV was not independently associated with AKI or hospital mortality. CKD developed in 14 of 110 (12.7%) patients with stage 3 AKI; none were dialysis-dependent.ConclusionsIn this large prospective multidisciplinary ICU cohort of younger patients, AKI was common, often associated with trauma in addition to traditional risk factors and was associated with good functional renal recovery at 90 days in most survivors. Although the HIV prevalence was high and associated with higher mortality, this was related to the severity of illness and not to HIV status per se.
Highlights
There is a marked paucity of data concerning Acute Kidney CI Confidence interval (Injury) (AKI) in Sub-Saharan Africa, where there is a substantial burden of trauma and Human Immunodeficiency Virus (HIV)
Vital status after Intensive Care Unit (ICU) discharge could not be established for 12 patients due to in-patient transfers to other hospitals and the unavailability of further records; six were in the AKI cohort, and outcomes were imputed
Mortality and AKI The development of AKI was associated with a higher in-hospital mortality rate of 31.8% compared to 7.2% in those without AKI (Hazards Ratio 4.07, 95% CI 2.66; 6.21; logrank p < 0.001 (Fig. 4))
Summary
There is a marked paucity of data concerning AKI in Sub-Saharan Africa, where there is a substantial burden of trauma and HIV. Regardless of the definition used, AKI is a well-recognized independent risk factor for mortality, is associated with substantial morbidity and is a current major cause for global concern [3,4,5,6]. There is a marked paucity of data from African ICU’s concerning the incidence, aetiology and effect of AKI on mortality and functional renal recovery, where the prevalence of HIV and trauma is high and where resources are often limited [6, 14, 15]. Renal replacement therapy is an expensive [16] and scarce resource in South Africa [17] and in particular, in the rest of sub-Saharan Africa [18, 19].
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