Community-acquired acute kidney injury in adults in Africa

Abstract

Aims: We review recent published data on demographics, causes, diagnoses, treatment, and outcome of acute kidney injury (AKI) in Africa. Methods: A review of the incidence, etiology, diagnoses, and treatment of AKI in adults in Africa from studies published between the years 2000 and 2015. Results: The incidence of AKI in hospitalized patients in Africa ranges from 0.3 to 1.9% in adults. Between 70 and 90% of cases of AKI are community acquired. Most patients with AKI are young with a weighted mean age of 41.3 standard deviation (SD) 9.3 years, and a male to female ratio of 1.2 : 1.0. Medical causes account for between 65 and 80% of causes of AKI. This is followed by obstetric causes in 5 – 27% of cases and surgical causes in 2 – 24% of cases. In the reported studies, between 17 and 94% of patients who needed dialysis received this. The mortality of AKI in adults in Africa ranged from 11.5 to 43.5%. Conclusions: Most reported cases of AKI in Africa originate in the community. The low incidence of hospital-acquired AKI is likely to be due to under ascertainment. Most patients with AKI in Africa are young and have a single precipitating cause. Prominent among these are infection, pregnancy complications and nephrotoxins. Early treatment can improve clinical outcomes.

Outcomes of acute kidney injury in a department of internal medicine in ABIDJAN (cote D'IVOIRE)

“…This prospective cohort study describes the profile of AKI in our daily practice. Numerous studies have shown that the epidemiology of AKI in developing countries is characterized by the young age of patients and a high incidence of infectious diseases 16 . However, data from sub-Saharan Africa published in recent years show that the average age of patients with AKI gradually increases, as is the case in our study 8,10 .…”

“…In African series, infections, toxins and gynaecologicalobstetrical causes are the main aetiologies of AKI 6,8,16 . The reduction of gynaecological-obstetrical AKI in our study is not only the result of public awareness of the risk of induced abortion, but also physicians training in Good Medical Practice.…”

“…Mortality is high during AKI development, varying from 21.9% to 67.3% depending on the series 6,8,16,28 . Mortality is higher in the group with AKI compared to the group without AKI 29 .…”

Clinical Profile and Outcome of Patients with Acute Kidney Injury Requiring Hemodialysis: Two Years’ Experience at a Tertiary Hospital in Rwanda

“…Acute kidney injury (AKI) is a common medical problem among hospitalized patients and may be associated with multiple etiologies, occurring singly or in combination, including infectious diseases or conditions such as diarrheal disease, HIV, malaria, glomerulonephritis and sepsis, toxins or herbal medications, autoimmune diseases, pregnancy-related conditions, trauma-related tubular injury, and iatrogenic causes including medications such as nonsteroidal anti-inflammatory drugs, hypovolemia, and contrast induced nephropathy [ 1 , 2 ]. While there is limited data, the incidence of AKI among hospitalized patients in Africa is estimated at 0.3–1.9% [ 3 ]. Country specific studies such as those in Malawi found an incidence of AKI of 17.2% [ 4 ].…”

The geographical distribution of dialysis services in Ghana

“…Acute kidney injury is also reported in hospital admissions and may require renal replacement therapy in severe cases. Mortality rates of acute kidney injury in adults in Africa ranges from 13.5-43.5% [14] and may increase in settings where dialysis services are unavailable.…”