Acute kidney injury in non-renal medical and surgical admissions in a secondary hospital in Cameroon: recognition and outcomes.

INTRODUCTION

there is a paucity of data on the burden of acute kidney injury (AKI) in non-renal medical and surgical admissions where renal function monitoring is not routinely done. This study evaluated the incidence and outcomes of AKI in non-renal medical and surgical admissions at risk of AKI.

METHODS

we prospectively assessed non-renal medical and surgical admissions at the Buea Regional Hospital during a 6-week period for AKI risk factors. Consenting participants with AKI risk factors were then screened for AKI using the modified KDIGO (Kidney Disease Improving Global Outcomes) criteria. We excluded patients with a history of Chronic Kidney Disease (CKD), confounders of serum creatinine (e.g. cimetidine, limb amputees), and those without a second serum creatinine value. Modifiable AKI risk factors were corrected and patients with AKI were presented to the nephrologist. Patients were followed up until hospital discharge or death. The outcome measures were the presence of AKI, need and access to dialysis, renal recovery on discharge, for both participants with and without AKI, death, and length of hospital stay.

RESULTS

a total of 165 (41.6% males) participants were included, and six were excluded. The mean (SD) age was 50.7 (17.29) years. Hypertension 43 (26.06%), obesity 28 (16.97%), Human Immunodeficiency Virus (HIV) 25 (15.15%), and diabetes mellitus 22 (13.33%) were the most frequent co-morbid conditions. Sepsis 110 (66.67%) and volume depletion 69 (41.82%) were the most common AKI risk factors. The incidence of AKI was 27.3% (n=45), with 35.6% (n=16) of these in KDIGO AKI stage 3. A total of 4 (8.9%) required dialysis with a 100% access rate. The in-hospital mortality was 6.6% (11/165), with the rate significantly higher in the AKI group (17.78%) compared to the non-AKI group (2.50%) (HR: 2.3, CI: 1.48-2.80, p=0.001). Complications of AKI accounted for 27.27% (3/11) of all causes of death. The median length of hospital stay was longer in the AKI group (11(6-15)) without a statistically significant difference compared to the non-AKI group (8(6-12.5)) (HR: 1.04, CI: 0.99-1.09, p=0.103). Renal recovery on discharge was complete in 62.2% of survivors.

CONCLUSION

the incidence of AKI is high in non-renal medical and surgical admissions at the Buea Regional Hospital and it is associated with a high mortality.