Dessalegn Mekonnen Nahom, Workneh Leulseged Tigist, Adane Minas Yared, Tadele Alemneh Zekarias, Hailu Gebeyehu Yonas, Tadesse Meshesha Thomas, Gurara Mebratu Abera, Tiruneh Gebremedhin Betelhem, Tesfa Lisanu Nathnael, Woldaregay Wagaye Bezawit, Bedel Ahmed Mowlid
Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, ETH.
Public Health, Medical Research Lounge, Addis Ababa, ETH.
Cureus. 2024 Sep 13;16(9):e69358. doi: 10.7759/cureus.69358. eCollection 2024 Sep.
Introduction The severe consequences of acute kidney injury (AKI) have been well-documented in high-risk patient populations. However, the effects of milder forms in non-critically ill patients remain understudied, particularly in resource-limited settings. While the risk of mortality associated with these cases is considered low, it can still lead to various complications including prolonged hospitalization, which may influence long-term renal and patient survival. Hence, the objective of this study was to study the impact of non-dialysis-requiring AKI (NDR-AKI) on survival outcomes of non-critically ill medical patients admitted to St. Paul's Hospital Millennium Medical College in Ethiopia during the period from July 2019 to January 2022. Methods A retrospective cohort study was conducted among 300 non-critically ill medical patients, 93 with NDR-AKI and 207 without AKI. Descriptive statistics, including frequency distributions and median survival times, were employed to summarize the data. Kaplan-Meier curves and the log-rank test were utilized to compare survival experiences of groups. A Cox proportional hazards survival model was fitted to estimate the impact of NDR-AKI on time to recovery. Adjusted hazard ratio (AHR) with 95% confidence interval (CI) was used to report findings. Results Two hundred four (68.0%) were discharged after improvement and the median recovery time was 16 days (95%CI: 13.5-18.5 days). Having NDR-AKI was associated with a 43% lower rate of achieving recovery (AHR=0.57, 95%CI=0.38, 0.84, p-value=0.004). Females were found to have a 1.41 times higher rate of recovery (AHR=1.41, 95%CI=1.03,1.94, p-value=0.033). Additionally, having tuberculosis (AHR=0.41, 95%CI=0.23,0.72, p-value=0.002) and being on anticoagulant (AHR=0.67, 95%CI=0.47,0.95, p-value=0.027) were associated with a 59% and 33% lower rate of recovery, respectively. Conclusion NDR-AKI significantly delays recovery compared to patients without AKI suggesting that even milder forms of AKI in non-critically ill patients can negatively impact patient outcomes. Early identification, prompt management, and addressing underlying causes are key to improving recovery and reducing long-term morbidity and mortality. Strict screening and monitoring of high-risk groups such as men, patients with tuberculosis, and those on anticoagulants is also crucial.
引言 急性肾损伤（AKI）的严重后果在高危患者群体中已有充分记录。然而，非危重症患者中较轻形式的AKI的影响仍未得到充分研究，尤其是在资源有限的环境中。虽然与这些病例相关的死亡风险被认为较低，但它仍可能导致各种并发症，包括住院时间延长，这可能会影响长期肾脏和患者生存。因此，本研究的目的是研究2019年7月至2022年1月期间，埃塞俄比亚圣保罗医院千禧医学院收治的非危重症内科患者中，非透析需求性急性肾损伤（NDR-AKI）对生存结局的影响。方法 对300例非危重症内科患者进行了一项回顾性队列研究，其中93例患有NDR-AKI，207例未患AKI。采用描述性统计，包括频率分布和中位生存时间，对数据进行总结。利用Kaplan-Meier曲线和对数秩检验比较各组的生存经历。采用Cox比例风险生存模型来估计NDR-AKI对恢复时间的影响。使用调整后的风险比（AHR）和95%置信区间（CI）报告研究结果。结果 204例（68.0%）患者病情改善后出院，中位恢复时间为16天（95%CI：13.5 - 18.5天）。患有NDR-AKI与恢复率降低43%相关（AHR = 0.57，95%CI = 0.38，0.84，p值 = 0.004）。发现女性的恢复率高出1.41倍（AHR = 1.41，95%CI = 1.03，1.94，p值 = 0.033）。此外，患有结核病（AHR = 0.41，95%CI = 0.23，0.72，p值 = 0.002）和正在接受抗凝治疗（AHR = 0.67，95%CI = 0.47，0.95，p值 = 0.027）分别与恢复率降低59%和33%相关。结论 与未患AKI的患者相比，NDR-AKI显著延迟了恢复，这表明即使是非危重症患者中较轻形式的AKI也可能对患者结局产生负面影响。早期识别、及时管理和解决潜在病因是改善恢复和降低长期发病率及死亡率的关键。对男性、结核病患者和接受抗凝治疗的患者等高风险群体进行严格筛查和监测也至关重要。
