Acute kidney injury among adult patients with sepsis in a low-income country: clinical patterns and short-term outcomes

Abstract

BackgroundAcute kidney injury (AKI) is a common complication of sepsis. We determined the prevalence of AKI among adult patients with sepsis on the medical wards in a low-income country and described their clinical pattern and outcomes at discharge.MethodsWe conducted a cross-sectional study of sepsis-related AKI on the adult medical wards of Mulago National Referral Hospital between January and April 2013. All patients meeting the American College of Chest Physicians (ACP) sepsis criteria were recruited. Demographic, clinical, laboratory and ultrasonography data were recorded and all patients with AKI were followed up to a maximum of 2 weeks. Proportional analysis was carried out and odds ratios with 95% confidence intervals were calculated in the bivariate analysis.ResultsOf 387 patients recruited, 217 (55.6%) were male and the average age was 37 years (range18–90 years). The prevalence of sepsis-related AKI was 16.3%. Age >59 years (p = 0.023), a postural drop in systolic blood pressure of >9 mmHg (p = 0.015) and a white blood cell count >12,000 cells/mL (p = 0.003) were significantly associated with AKI. In-hospital mortality among patients with AKI was 21% (13/63). 59% (20/49) of patients who were discharged alive or were still on the wards after 2 weeks had persistent kidney injury. Acute Kidney Injury Network (AKIN) Stage 3 was significantly associated with persistence of kidney injury (p = 0.001). None of the patients requiring dialysis or ICU care received either because of limited access.ConclusionsThe prevalence, morbidity and mortality due to AKI among sepsis patients in Uganda is very high and limited access to dialysis and ICU care is a major factor in poor outcomes for these patients.

Acute kidney injury: risk factors and management challenges in developing countries

“…15 Two studies from India have shown that the AKI incidence in inpatient wards and pediatric intensive care units ranged between 5%-9% and 25%-36%, respectively. 11,12 In a recent study from the largest hospital in Uganda, the AKI prevalence among patients admitted with sepsis was 16%, and the hospital mortality was 21% for patients with septic AKI. 10 The cause of AKI can be broadly categorized as hospital acquired and community acquired (Table 1).…”

“…9,10 On the other hand, AKI commonly occurs in the community in less-developed nations. 11 However, in this article, it is difficult to define the incidence of AKI, since no nationwide disease registries exist and data are usually derived from single-center experiences.…”

“…2,3,5,[11][12][13][14] Children and young adults in developing countries are disproportionately affected by AKI as a result of infections, volume depletion due to severe diarrhea, pregnancy-related events, or animal envenomation. 2 In these poor regions, in some series, children constituted >15% of patients with AKI.…”

Nurses' knowledge to identify early acute kidney injury

“…The lack of properly trained professionals aware of the problem may delay the detection and referral to specialized services, leading to worse results (1)(2)(3)(4)(5)(6)(7)(8) .…”

“…It may be present in the community and in hospital settings. Sepsis is the most common cause of AKI in critical patients and is associated with higher severity, increasing risk of death and hospital admissions, compared to non-septic patients (2) . In intensive care units (ICU), its incidence may reach 20%, and 49% to 70% of patients need dialytic treatment (3)(4) .…”