Prevalence, Characteristics and Outcome of Post-Operative Acute Kidney Injury in Cameroon: A Prospective Study in Three Hospitals in Douala

Abstract

Objective: Post-operative acute kidney injury (AKI) is a frequent surgical complication. Data on this disorder are scare in our setting. We aimed to study the prevalence, characteristics and outcome of postoperative AKI in Cameroon. Methods: A prospective and analytical study from December 2020 to Mai 2021 including all consenting adults’ patients admitted in the departments of surgery, obstetrics/gynecology and intensive care unit (ICU) of 3 referral hospitals in Douala. For each patient, 3 serum creatinine assays were done on admission before the surgery, on days 2 and 7 after surgery. Postoperative AKI was defined and classified according to the modified KDIGO 2012 criteria. Outcome measure were kidney recovery at day 7 and mortality. Kidney recovery was total if serum creatinine on day 7 was less or equal to the preoperative value, partial if less than diagnostic value of day 2 but not the preoperative value and absent if creatinine on day 7 did not decrease or if the patient required dialysis. p <0.05 was considered significant. Result: Out of 203 patients included, 52 developed postoperative AKI, giving a prevalence of 26.6%. Mean age of AKI patients was 35.34 (13.74) years with 61.6% being (32/52) male; AKI stage 1 accounts for 55.7% (29/52), 19.3% (10/52) stage 2 and 25% (13/52) stage 3. AKI was functional in 61.5% (32/52) of cases mainly due to hypovolemia 42.5% (22/52) and sepsis 34.6% (18/52). For the 40 patients diagnosed on D2, kidney recovery was known in 75% (30/40); with 66.6% (20/30) total recovery, 23.4% (7/30) partial recovery and 10 % (3/30) without recovery. Mortality rate was 19% (10/52) mainly due to hemorrhagic shock. Intra operative hypotension (aOR: 6.09; CI: 1.4 - 26.33; p = 0.016) and dirty surgery (aOR: 6.22; CI: 1.35 - 28.75; p = 0.019) were factors associated with AKI. Conclusion: Postoperative AKI occurred in 1/4 of patients in our setting. It is mainly due to hypovolemia and sepsis, renal recovery and mortality were high.