Clinical Characteristics and 30-Day Outcomes of Intermittent Hemodialysis for Acute Kidney Injury in an African Intensive Care Unit

Abstract

Introduction. Acute kidney injury (AKI) is a common occurrence in the intensive care unit (ICU). Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD) in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT) is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU. Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients' demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality. Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2–17.5, p = 0.028), mechanical ventilation (OR 13.063; 95% CI 2.3–72, p = 0.003), and need for vasopressors (OR 16.8; 95% CI 3.4–82.6, p = 0.001) had statistically significant association with mortality. Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available.

Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study

“…However, only the DRC study reported HIV prevalence, which was low at 2.9%. Consistent with other LMI countries, patients were younger than in HI country cohorts (mean age 40.6 years) with lower comorbidity rates [1, 18, 19, 29–32], mostly of Black African ethnicity, and were representative of the local community that we serve [21].…”

“…However, there is a marked paucity of data from African ICU’s concerning the incidence, aetiology and effect of AKI on mortality and functional renal recovery, where the prevalence of HIV and trauma is high and where resources are often limited [6, 14, 15]. Renal replacement therapy is an expensive [16] and scarce resource in South Africa [17] and in particular, in the rest of sub-Saharan Africa [18, 19].…”

An epidemiologic overview of acute kidney injury in intensive care units

“…In the presence of sepsis, the reported incidence of AKI was greater than 70%, and mortality rate reached 80%, higher in patients undergoing RRT, 1,10,11,14,17,24,34,36,37,[39][40][41][42][43] Sepsis was also an independent factor that increased the length of stay of individuals in ICUs. 11 The pathophysiological dynamics of the interaction between sepsis and AKI are not fully understood, and the association between sepsis and AKI in ICU patients can cause vascular, glomerular, tubular, and interstitial damage in the kidneys.…”

Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients

“…Requirement for mechanical ventilation [5,28], vasopressors [28], and acute cardiovascular failure [6] have been associated with increased mortality in AKI patients. KDIGO guidelines recommend CRRT as the modality of RRT choice in hemodynamic instability, based mostly on theoretical advantage for better fluid balance control and circumstantial evidence of improvement of cardiovascular parameters [14].…”