RISK FACTORS FOR DEVELOPMENT OF ACUTE KIDNEY INJURY IN HOSPITALISED ADULTS IN ZIMBABWE

A GILBERT1, L ROBERTSON2, J HERON1, S CHADBAN1,3, C NDHLOVU2, R DAHWA2, D GRACEY1,4

1Royal Prince Alfred Hospital, 2University of Zimbabwe , 3Kidney Node, Charles Perkins Centre, University of Sydney, 4Central Clinical School, Faculty of Medicine, University of Sydney

Aim: To examine the prevalence of, and risk factors for, acute kidney injury (AKI) in a cohort of hospitalised patients in Zimbabwe.
Background: AKI is predominantly a disease of low and middle-income countries. Despite this, there is a paucity of data regarding AKI in Africa. Most published studies were conducted prior to the most recent Kidney Disease: Improving Global Outcomes (KDIGO) definition of AKI. This prospective, observational, cohort study examines AKI amongst acute medical inpatients in a large tertiary hospital in Harare, Zimbabwe.
Methods: All newly admitted, adult, medical patients in randomly selected, 24-hour periods were included. Baseline demographic information, comorbidities, nephrotoxic medication use, and reason for admission were recorded. A serum creatinine measurement was performed on admission and again after 48 hours. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and AKI was defined using the most recent KDIGO definition as an increase in the serum creatinine of greater than 26.5µmol/L within 48 hours, with admission creatinine used as a baseline measurement.
Results: 253 patients were included in the analysis; 137 patients (54.2%) were female. 36 patients (14.2%) met the KDIGO criteria for AKI during the 48-hour follow-up period. AKI was more common among males (19.8% vs 9.5%; p=0.019). In logistic regression, AKI was related negatively to female sex (OR 0.461, 95% CI 0.211, 1.003; p=0.051) and positively predicted by the presence of comorbid hypertension (OR 3.292, 95% CI 1.52, 7.128; p=0.003) and chronic kidney disease (OR 6.034, 95% 1.792, 20.313; p=0.004).
Conclusions:  KDIGO-defined AKI was common in hospitalised patients in Sub-Saharan Africa and was predicted by male sex, comorbid hypertension and comorbid chronic kidney disease.


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