Hospital-Acquired Acute Kidney Injury in Non-critical Medical Patients in a Developing Country Tertiary Hospital: Incidence and Predictors

Abstract

Background: Acute kidney injury (AKI) is a frequent complication in critical patients leading to worse prognosis. Although the consequences of AKI are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Hence, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia. Methods: A retrospective chart review study was conducted among 232 hospitalized non-critical medical patients admitted to St. Paul's Hospital Millennium Medical College between January 2020 and January 2022. Data was characterized using frequency and median with interquartile range. To identify predictors of HAAKI, a log binomial regression model was fitted at a p value of ≤ 0.05. The magnitude of association was measured using adjusted relative risk (ARR) with its 95% CI. Results: During the median follow-up duration of 11 days (IQR, 6-19 days), the incidence of HAAKI was estimated to be 6.0 per 100 person-day observation (95% CI= 5.5 to 7.2). Significant predictors of HAAKI were found to be having type 2 diabetes mellitus (ARR=2.36, 95% CI= 1.03, 5.39, p-value=0.042), and taking vancomycin (ARR=3.04, 95% CI= 1.38, 6.72, p-value=0.006) and proton pump inhibitors (ARR=3.80, 95% CI = 1.34,10.82, p-value=0.012). Conclusions: HAAKI is a common complication in hospitalized non-critical medical patients, and is associated with a common medical condition and commonly prescribed medications. Therefore, it is important to remain vigilant in the prevention and timely identification of these cases and to establish a system of rational prescribing habits.