In-hospital mortality of HIV-positive patients with acute kidney injury a decade after the roll-out of anti-retroviral therapy in Cape Town, South Africa

Abstract

Background: Acute kidney injury (AKI) in HIV-infected patients in sub-Saharan Africa is a common cause of hospitalisation and is associated with high morbidity and mortality. There is a paucity of comparative data regarding the outcomes of AKI in those patients with and without HIV infection from the African continent. Methods: This was a single-centre retrospective study of all consecutive adult patients with AKI referred to the renal unit at Tygerberg Hospital for the period January 2015 to December 2016. The diagnosis of AKI required evidence of the following: a recent normal serum creatinine and/or normal kidney sizes on ultrasound examination and/or granular casts on urine microscopy. Kaplan-Meier curves and logistic regression were used to assess survival and identify factors predicting mortality. Results: We identified a total of 291 patients with AKI of whom 116 (40%) were HIV positive. HIV-positive patients had a mortality rate of 34.5% vs. 29.1% in the HIV-negative patients (P = 0.34). At hospital admission, HIV-positive patients had a higher admission serum creatinine (551 μmol/L vs. 190 μmol/L, P < 0.01). Of those who died, the HIV-positive patients were younger (41 vs. 52 years, P < 0.01), predominantly Black (87.5% vs. 23.5%, P < 0.01) and were mostly admitted to medical wards (92.5% vs. 41.2%, P < 0.01). There was no difference in mortality related to the use of renal replacement therapy (P = 0.50). Logistic regression identified mixed ancestry (OR 2.47, P = 0.02), HIV infection (OR 2.69, P < 0.01) and surgical ward admission (OR 2.05, P = 0.03) as predictors of death. Conclusions: In-hospital mortality of AKI was high, and HIV infection was associated with a greater risk of death. This may be the result of late presentation of both the AKI as well as the HIV infection.

Outcomes of hospitalised patients with hyperkalaemia at a South African tertiary healthcare centre

“…We have previously reported high in-hospital mortality rates for patients with AKI that was predominantly caused by infectious disease, trauma and pregnancy-related complications. 20 , 21 Regardless of the cause, the abrupt loss of kidney function may be associated with a rapid rate of rise in the [K], which has been identified as a factor predisposing to cardiac arrhythmias and death. 22 , 23 …”

“…Although there was no difference in the proportion of patients with AKI between the groups, the severity was greater in HIV patients, which might be related to late presentation. 20 …”

Acute kidney injury in an HIV patient with plasmablastic lymphoma – A double-edged sword

“…People living with HIV frequently develop acute kidney injury (AKI) because of sepsis and diarrhoeal disease. 1 Another less common cause of AKI is lymphoma, which is frequently of B cell origin. It may affect the kidneys by several mechanisms that include lymphomatous infiltration of kidney parenchyma (LIK), urinary tract obstruction, tumour lysis syndrome or consequences of nephrotoxic chemotherapy.…”

Acute kidney injury after major non-cardiac surgery: Incidence and risk factors

“…[11] South African (SA) studies on AKI have predominantly focused on medical patients. Local literature includes studies on hospitalised patients (predominantly medical), [3] HIV-positive patients, [12] COVID-19 patients, [13] post-cardiac surgery patients, [7] medically and surgically managed trauma patients [14] and critically ill patients. [15,16] However, there is a paucity of local literature on non-cardiac post-surgical AKI studies.Developing countries, such as SA, often have different patient characteristics compared with patients studied in the developed world.…”