Incidence and Predictors of Acute Kidney Injury Among Critically Ill Adult Patients Admitted at Mbarara Regional Referral Hospital.

IF 2.1 Q2 UROLOGY & NEPHROLOGY

International Journal of Nephrology and Renovascular Disease Pub Date : 2025-07-05 eCollection Date: 2025-01-01 DOI:10.2147/IJNRD.S524082

Rose Muhindo, Joshua Kiptoo, Christine Tumuhimbise, Caroline Nakyanzi, Francis Gonzaga Ssentongo, Michael Kavubu, Ernest Ssewanyana, John Isiiko, Julius Kyomya, Andrew Mutekanga, Alum Rachel Aguma, Judith Owokuhaisa, Tadele Mekuriya Yadesa

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Abstract

Background: Severely ill patients are vulnerable to developing Acute Kidney Injury (AKI), with variable incidence, but limited data from LMICs. We evaluated the incidence, predictors, treatment, and outcomes of AKI among very ill adult patients at a public tertiary hospital in southwestern Uganda.

Methods: This prospective cohort study categorized patients who had a NEWS-2 above 5 as critically ill. We used the "Kidney Disease Improving Global Outcomes (KDIGO)" definition of AKI as a 0.3 mg/dl increase in serum creatinine within 48 hours. Participants were followed up until day 7 of admission, death or discharge, whichever occurred first. STATA version 13 was used for data analysis. Predictors of AKI were determined by logistic regression.

Results: Of 161 critically ill patients, the median age was 48 years (IQR: 31-65). The incidence of AKI was 70 (95% CI 55-90) per 1000 person days of observation. About, 39.1% (127) drugs used during hospitalization were deemed potentially nephrotoxic, and 60% (96) of participants were exposed to at least one nephrotoxic drug. Penicillins and loop diuretics were the most commonly used nephrotoxic drugs. Predictors of AKI included: previous hospitalization in the last 3 months (aOR 2.56, 95% CI: 1.08-6.06, P=0.032), admission to the surgical ward (aOR 4.32, 95% CI: 1.22-15.24, P=0.023), elevated baseline creatinine (>1.2 mg/dl) (aOR 2.44, 95% CI: 1.13-5.27, P=0.023) and elevated baseline WBC count (>12 × 10⁹/µL) (aOR 2.57, 95% CI: 1.21-5.46, P=0.014). Most AKI patients were managed conservatively; 25% of patients with stage 3 received hemodialysis, and 25% of those with incident AKI died in the hospital.

Conclusion: We found a high prevalence of AKI among critically ill patients (70 per 1000 person days). Previous hospitalization in the past 3 months, high baseline creatinine, high baseline WBC count and admission to the surgical ward were independently associated with AKI.

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姆巴拉拉地区转诊医院危重成年患者急性肾损伤的发生率及预测因素

背景：重症患者易发生急性肾损伤（AKI），其发生率不同，但来自低收入国家的数据有限。我们评估了乌干达西南部一家公立三级医院重症成人AKI患者的发病率、预测因素、治疗和结局。方法：前瞻性队列研究将NEWS-2≥5分的患者归为危重患者。我们使用了“肾病改善全球预后（KDIGO）”对AKI的定义，即48小时内血清肌酐升高0.3 mg/dl。随访至入院、死亡或出院第7天，以先发生者为准。使用STATA version 13进行数据分析。通过逻辑回归确定AKI的预测因素。结果：161例危重患者中位年龄为48岁（IQR: 31-65）。AKI的发生率为每1000人日观察70例（95% CI 55-90）。住院期间使用的药物约39.1%（127）被认为有潜在的肾毒性，60%（96）的参与者暴露于至少一种肾毒性药物。青霉素类和环状利尿剂是最常用的肾毒性药物。AKI的预测因素包括：最近3个月内的住院经历（aOR 2.56, 95% CI: 1.08-6.06， P=0.032）、住院时间（aOR 4.32, 95% CI: 1.22-15.24， P=0.023）、基线肌酐升高（aOR 2.44, 95% CI: 1.13-5.27， P=0.023）和基线白细胞计数升高（aOR 2.57, 95% CI: 1.21-5.46， P=0.014）。大多数AKI患者采用保守治疗；25%的3期患者接受了血液透析，25%的急性肾损伤患者在医院死亡。结论：我们发现AKI在危重患者中的患病率很高（70 / 1000人天）。过去3个月的住院史、高基线肌酐、高基线白细胞计数和入住外科病房与AKI独立相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Nephrology and Renovascular Disease UROLOGY & NEPHROLOGY-

CiteScore

3.90

自引率

5.00%

发文量

审稿时长

16 weeks

期刊介绍： International Journal of Nephrology and Renovascular Disease is an international, peer-reviewed, open-access journal focusing on the pathophysiology of the kidney and vascular supply. Epidemiology, screening, diagnosis, and treatment interventions are covered as well as basic science, biochemical and immunological studies. In particular, emphasis will be given to: -Chronic kidney disease- Complications of renovascular disease- Imaging techniques- Renal hypertension- Renal cancer- Treatment including pharmacological and transplantation- Dialysis and treatment of complications of dialysis and renal disease- Quality of Life- Patient satisfaction and preference- Health economic evaluations. The journal welcomes submitted papers covering original research, basic science, clinical studies, reviews & evaluations, guidelines, expert opinion and commentary, case reports and extended reports. The main focus of the journal will be to publish research and clinical results in humans but preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies and interventions.