Epidemiology and Outcomes of Dialysis-Requiring Acute Kidney Injury at Chris Hani Baragwanath Hospital

Abstract

Background: Acute kidney injury (AKI) occurs commonly within the hospital setting and is associated with a high rate of morbidity and mortality. Factors such as social, economic and ethical dilemmas are closely associated with initiation of dialysis in the public health sector. Methods: A retrospective review of 324 patients presenting with kidney failure who were initiated on acute dialysis at the Chris Hani Baragwanath Hospital was carried out over a 2-year period from July 2009 to June 2011. Results: The mean age at presentation was 40 ± 13 years; 57% of patients were male and 92% were Black. HIV positivity occurred in 26% of patients. The leading indications for acute dialysis included decompensated chronic kidney disease (38.9%), acute tubular necrosis (ATN) (38.3%), HIV-related kidney disease (13.6%), malaria (5.7%), pregnancy-related kidney disease (7.4%) and glomerulonephritis (7.4%). ATN was the predominant cause of AKI in HIV-positive patients. The overall renal recovery rate was 31%, and the overall mortality rate was 23%. About 44.6% of patients had chronic consequences, with 23% being transferred to chronic renal replacement therapy (RRT) and 21.6% transferred to renal outpatients (ROPD) with cessation of dialysis; 1.4% were lost to follow-up. While HIV-positive patients had a better renal recovery rate compared to HIV-negative patients (36% versus 26%; p < 0.0001), they had a higher mortality rate compared to their HIV-negative counterparts (34% versus 19%; p < 0.0001). Conclusion: AKI remains a common presentation that often requires dialysis, a precious resource in an already overburdened health system, and occurs at similar rates in HIV-positive and HIV-negative patients. The underlying aetiology of AKI at Chris Hani Baragwanath resembles that of other developing countries with ATN, malaria, sepsis and pregnancy-induced kidney injury amongst the leading causes. High mortality rates were observed in patients with ATN, in both HIV-positive and HIV-negative patients.