Causes and outcome of acute kidney injury amongst adults patients in two hospitals of different category in Cameroon; a 5 year retrospective comparative study

Abstract

Background Acute kidney injury (AKI) is an under-recognized disorder, which is associated with a high risk for mortality, development of chronic kidney disease (CKD). Objective We sought to describe and compare the causes and outcomes of AKI amongst adult patients in Douala general hospital (DGH) and Buea regional hospital (BRH). Methods A hospital-based retrospective cohort analytic study was carried from February to April 2021. Convenience sampling was used. We included Patient’s files admitted from January 2016 to December 2020 aged > 18 years, with AKI diagnosed by a nephrologist and recorded values of serum creatinine (sCr) on admission and discharge. Data were analysed using SPSSv26. Chi-square, fisher, median mood’s and regression logistic test were used, values were considered significant at p < 0.05. Results Of the 349 files included 217 was from DGH and 132 from BRH. Community acquired AKI were more present in BRH 87.12% (n = 115) than DGH 84.79% (n = 184) (p = 0.001). Stage III AKI was the most common presentation in both hospital. Pre-renal AKI was more common (p = 0.013) in DGH (65.44%, n = 142) than BRH (46.97%, n = 62). Sepsis and volume depletion were more prevalent in urban area with (64.51 and 30.41% vs. 46.21 and 25.75%) while severe malaria was more present in Semi-urban area (8.33% vs. 1.84%, p = 0.011). Complete and partial renal recovery was 64.97% (n = 141) in DGH and 69.69% (n = 92) in BRH (p = 0.061). More patients had dialysis in BRH 73.07% (n = 57) than in DGH 23.33% (n = 21). More patient died in DGH 33.18% (n = 72) died than in BRH 19.70% (n = 26) (p = 0.007). Stage III was significantly associated with non-renal recovery in both DGH (p = 0.036) and BRH (p = 0.009) while acute tubular necrosis was associated with non-renal outcome in DGH (p = 0.037). Conclusions AKI was mainly due to sepsis, volume depletion and nephrotoxicity. Complete and partial recovery of kidney function were high in both settings. Patient outcome was poorer in DGH.

Nephrology consultation improves the clinical outcomes of patients with acute kidney injury

“…AKI during the ICU stay was detected retrospectively based on the KDIGO serum creatinine criteria of an increase in the serum level of creatinine of ≥0.3 mg/dL within 48 hours [26]. Resolving AKI was also retrospectively defined as the decrease in serum creatinine level of ≥0.3 mg/dL within 48 hours [27][28][29]. The urine output criterion was ignored.…”