Risk factors for development of acute kidney injury in hospitalised adults in Zimbabwe

Abstract

Background Acute kidney injury (AKI) is predominantly a disease of low and middle-income countries. Despite this, there is a particular paucity of data regarding AKI in Africa. Most published studies were conducted prior to the most recent Kidney Disease: Improving Global Outcomes (KDIGO) definition of AKI. This prospective, observational, cohort study examines AKI amongst newly admitted acute medical inpatients in a large, urban, tertiary hospital in Harare, Zimbabwe. Methods All newly admitted, adult, medical patients in separate, randomly selected, 24-hour periods were included. Baseline demographic information, comorbidities, nephrotoxic medication use, and reason for admission were recorded on a standardised data capture record. A serum creatinine measurement was performed on all patients at the time of admission and again after 48 hours. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and AKI was defined using the most recent KDIGO definition as an increase in the serum creatinine of greater than 26.5μmol/L within 48 hours, with admission creatinine used as a baseline measurement. Results 253 patients were included in the analysis; 137 patients (54.2%) were female; 100 patients (39.5%) had HIV infection. 36 patients (14.2%) met the KDIGO criteria for AKI during the 48-hour follow-up period. AKI was more common among males (19.8% vs 9.5%; p = 0.019). The AKI group had a higher serum creatinine at presentation than those without AKI (296.5μmol/L vs 91.0μmol/L; p<0.001) and at 48 hours (447.7μmol/L vs 77.1μmol/L; p<0.001). In logistic regression, AKI was related negatively to female sex (OR 0.461, 95% CI 0.211, 1.003; p = 0.051) and positively predicted by the presence of comorbid hypertension (OR 3.292, 95% CI 1.52, 7.128; p = 0.003) and chronic kidney disease (OR 6.034, 95% 1.792, 20.313; p = 0.004). Conclusions KDIGO-defined AKI was common in hospitalised patients in Sub-Saharan Africa and was predicted by male sex, a history of comorbid hypertension and a history of comorbid chronic kidney disease.

Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature

“…In Benin, Vigan et al showed that AKI was present in 11.8% of all adult admissions in two large hospitals in Cotonou [ 31 ]. In a prospective cohort of 253 Zimbabwean adults newly admitted to a large tertiary hospital in Harare, Gilbert et al recorded 14.2% AKI [ 32 ]. In Malawi, Evans et al in a prospective study of general medical admissions to a tertiary hospital in Blantyre found 17.2% of patients with AKI [ 33 ].…”

“…Male sex appears to be a risk factor for AKI in most African studies [ 8 , 32 , 38 ]. The fact that male patients predominate in African series is often attributed by some authors to poor access of females to health care.…”

“…In contrast, others suggest that there is a biological or environmental sensitivity to AKI in males [ 8 ]. It should also be emphasised that, as shown by two recent studies from southern Africa, this is not a case of female underrepresentation but of a highly significant association between male sex and the occurrence of AKI [ 32 , 38 ].…”

“…Apart from the above comorbidities, Chronic Kidney Disease (CKD) has also been shown to be an independent risk factor for the development of AKI. Various African studies have shown that CKD is one of the strongest predictors of AKI [ 32 , 38 , 47 ]. After logistic regression, a Zimbabwean study found that the odds of developing AKI were 3.3 for elevated blood pressure and 6.0 for CKD [ 32 ].…”

“…Various African studies have shown that CKD is one of the strongest predictors of AKI [ 32 , 38 , 47 ]. After logistic regression, a Zimbabwean study found that the odds of developing AKI were 3.3 for elevated blood pressure and 6.0 for CKD [ 32 ]. In a Sudanese cohort, cardiovascular disease (adjusted odds ratio (AOR) = 3.4; 95% Confidence Intervals (95% CI): 1.2–9.4), diabetes mellitus (AOR = 2.6; 95% CI: 1.2–6.0) and hypertension (AOR = 2.4; 95% CI: 1.2–5.4) were significant predictors of the development of AKI [ 44 ].…”