Acute Kidney Injury in ICU: Prevalence andOutcome at Muhimbili National Hospital, Dar es Salaam, Tanzania

Abstract

Background: Acute Kidney Injury (AKI) is common among hospitalized patients worldwide and has a poor prognosis among Intensive Care Unit (ICU) patients with mortality rates ranging from 10-90%. There is a paucity of data on the burden and spectrum of AKI in lower income countries especially those in sub-Saharan Africa region. This study was conducted at Muhimbili National Hospital (MNH) to determine the prevalence and outcome of AKI among patients admitted in ICU. Methodology:This was a retrospective descriptive study of all patients admitted to the MNH-ICU from January 2009 through December 2012. Medical records of the patients admitted to the ICU during the study period were reviewed and those with AKI were identified. Standardized pre-tested data instrument tools were used to collect socio-demographic data, clinical and laboratory parameters which included; date of admission to the ICU, type of patient (surgical or medical patient), duration of ICU stay, modality of ICU treatment for AKI, need for mechanical ventilation, or inotropic support and outcome.Results: A total of seven hundred and sixty-eight (768) patients were admitted to the MNH-ICU during the study period 2009-2012. Two hundred and thirty-three (233) case notes of patients met inclusion criteria for recruitment, were reviewed and included in the final analysis. Out of 233 participants, males were 60.9% and mean age of participants was 45.7 ± 17.8 years. The prevalence of AKI in this study was 57.9% (135/233) with the different AKIN stages contributing: I-(19.2%), II-(28.1%) and III-(52.6%). %). The length of stay in the ICU for those with AKI was 2 days (IQR 2-6) while that for those with no AKI was 3 days (IQR 2-8), P=0.094. Mortality among patients with AKI was higher than in those without AKI, 94.1% (127/135) compared to 91.8% (90/98), p=0.0037. For patients with AKI, 67.4% were recorded as having sepsis while 15.5% had septic shock. Factors associated with mortality included underlying CKD (p=0.011), the need for mechanical ventilation (p=0.046), and the need for vasopressor in ICU (p=0.018). Conclusion:The prevalence of AKI was high (57.9%) with high mortality of 94.1% Mortality. Factors associated with mortality included underlying CKD, the need for mechanical ventilation and vasopressors.