Abstract
Epidemiology of acute kidney injury (AKI) in developing countries is under-studied. We evaluated the risk and prognosis of AKI in patients admitted to intensive care units (ICUs) in Egypt. We recruited consecutive adults admitted to ICUs in Alexandria Teaching Hospitals over six months. We used the KDIGO criteria for AKI. We followed participants until the earliest of ICU discharge, death, day 30 from entry or study end. Of the 532 participants (median age 45 (Interquartile range [IQR]: 30–62) years, 41.7% male, 23.7% diabetics), 39.6% had AKI at ICU admission and 37.4% developed AKI after 24 hours of ICU admission. Previous need of diuretics, sepsis and low education were associated with AKI at ICU admission; APACHE II score independently predicted AKI after ICU admission. A total of 120 (22.6%) patients died during 30-day follow-up. Compared to patients who remained AKI-free, mortality was significantly higher in patients who had AKI at study entry (Hazard Ratio [HR] 2.14; 95% Confidence Interval [CI] 1.02–4.48) or developed AKI in ICU (HR 2.74; 95% CI 1.45–5.17). The risk of AKI is high in critically ill people and predicts poor outcomes. Further studies are needed to estimate the burden of AKI among patients before ICU admission.
Highlights
Four in five cases of acute kidney injury (AKI) occur in the developing world[1,2]
Predictors of mortality remained the same (Table S5). In this multicenter study of over 500 consecutive patients admitted to intensive care units (ICUs) in Alexandria Teaching Hospitals in Egypt, we found that about 40% of patients admitted to ICU had AKI at presentation, and a similar proportion of those who were AKI-free on admission developed AKI during their ICU stay
AKI was associated with high mortality or prolonged hospital stay regardless of its severity and the association between AKI and poor outcomes persisted in analyses that accounted for different potential confounders, including different admission diagnoses and clinical characteristics
Summary
Four in five cases of AKI occur in the developing world[1,2]. Geographical, etiological, cultural, and economic reasons may underlie potential disparities in the risk of AKI between and within higher and lower income countries. The risk of AKI varies between urban and rural areas, by season and cultural mores, and according to the distribution of infectious agents. The risk and prognosis of AKI vary with the availability of transportation services and health care resources, including medications, equipment, trained personnel, and dialysis facilities[13,14]. Accurate estimates of the risk of AKI and factors affecting AKI-related outcomes in low-resource regions are key steps towards the design and implementation of initiatives to reduce AKI-related morbidity and mortality. To address this knowledge gap, we estimated the risk of AKI at the time of admission and after admission to ICU in the four Alexandria Teaching Hospitals. We studied the prognosis of AKI in this high-risk population
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