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Corrêa EA, Barreto J, Lussim L, Carbonara CEM, Macedo E, Oliveira RB. Community-acquired acute kidney injury in Southeast Brazil and independent risk predictors: a prospective cohort study. J Nephrol 2024:10.1007/s40620-024-01953-4. [PMID: 38809357 DOI: 10.1007/s40620-024-01953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/01/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The prevalence and risk factors for community-acquired acute kidney injury (CA-AKI) are unknown. This study aimed to explore the incidence of CA-AKI in a tertiary care center and to depict the main clinical characteristics related to this condition. METHODS This was a prospective cohort study involving patients admitted to the emergency department (Hospital de Clínicas, UNICAMP, Campinas, Brazil) between January 2019 and September 2021. Adults (≥ 18 yrs) who presented to the emergency room with symptoms potentially associated with an increased risk of AKI were included. Individuals with a prior diagnosis of stage 5 chronic kidney disease or with a confirmed COVID-19 infection were excluded. A score based on clinical signs and symptoms was assigned to predict the risk of severe AKI. RESULTS Of the 261 patients enrolled, CA-AKI was diagnosed in 65 (25%). The CA-AKI group was older [57(± 14) vs. 51(± 18) years, p = 0.02] and had a lower baseline estimated glomerular filtration rate [103 (88-113) vs. 109 (97-121) mL/min/1.73 m2; p = 0.01]. Logistic regression showed that scores ≥ 7 points [odds ratio (OR) 2.8 (1.281-6.133), 95% confidence interval (CI), p = 0.01], age [OR 1.02 (1.007-1.044), 95% CI, p = 0.008] and liver disease [OR 2.6 (1.063-6.379), 95% CI, p = 0.03] were independently related to CA-AKI. CONCLUSION The incidence of CA-AKI was not negligible among patients admitted to a tertiary care center; CA-AKI can be suspected on a clinical basis and confirmed by serum creatinine. Age, liver disease and higher scores in risk prediction tools were related to an increased incidence of CA-AKI.
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Affiliation(s)
- Eric Aragão Corrêa
- School of Medical Sciences, Universidade Estadual de Campinas, U.N.I.C.A.M.P., Campinas, SP, Brazil
| | - Joaquim Barreto
- Laboratory of Atherosclerosis and Vascular Biology, Division of Cardiology, U.N.I.C.A.M.P., Campinas, SP, Brazil
| | - Lygia Lussim
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas, U.N.I.C.A.M.P., Campinas, SP, Brazil
| | - Cinthia Esbrile Moraes Carbonara
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas, U.N.I.C.A.M.P., Campinas, SP, Brazil
| | - Etienne Macedo
- Division of Nephrology, Department of Medicine, University of California, San Diego, USA
| | - Rodrigo Bueno Oliveira
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas, U.N.I.C.A.M.P., Campinas, SP, Brazil.
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Spencer SA, Malowa F, McCarty D, Joekes E, Phulusa J, Chinoko B, Kaimba S, Keyala L, Mandala P, Mkandawire M, Mlongoti M, Mnesa B, Mukatipa A, Mijumbi R, Nyirenda M, Sawe HR, Henrion M, Augustine DX, Oxborough D, Worrall E, Limbani F, Dark P, Gordon SB, Rylance J, Morton B. Causes, outcomes and diagnosis of acute breathlessness hospital admissions in Malawi: protocol for a multicentre prospective cohort study. Wellcome Open Res 2024; 9:205. [PMID: 39157428 PMCID: PMC11327656 DOI: 10.12688/wellcomeopenres.21041.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 08/20/2024] Open
Abstract
Background Hospital admission due to breathlessness carries a significant burden to patients and healthcare systems, particularly impacting people in low-income countries. Prompt appropriate treatment is vital to improve outcomes, but this relies on accurate diagnostic tests which are of limited availability in resource-constrained settings. We will provide an accurate description of acute breathlessness presentations in a multicentre prospective cohort study in Malawi, a low resource setting in Southern Africa, and explore approaches to strengthen diagnostic capacity. Objectives Primary objective: Delineate between causes of breathlessness among adults admitted to hospital in Malawi and report disease prevalence. Secondary objectives : Determine patient outcomes, including mortality and hospital readmission 90 days after admission; determine the diagnostic accuracy of biomarkers to differentiate between heart failure and respiratory infections (such as pneumonia) including brain natriuretic peptides, procalcitonin and C-reactive protein. Methods This is a prospective longitudinal cohort study of adults (≥18 years) admitted to hospital with breathlessness across two hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Chiradzulu, Malawi. Patients will be consecutively recruited within 24 hours of emergency presentation and followed-up until 90 days from hospital admission. We will conduct enhanced diagnostic tests with robust quality assurance and quality control to determine estimates of disease pathology. Diagnostic case definitions were selected following a systematic literature search. Discussion This study will provide detailed epidemiological description of adult hospital admissions due to breathlessness in low-income settings, which is currently poorly understood. We will delineate between causes using established case definitions and conduct nested diagnostic evaluation. The results have the potential to facilitate development of interventions targeted to strengthen diagnostic capacity, enable prompt and appropriate treatment, and ultimately improve both patient care and outcomes.
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Affiliation(s)
- Stephen A. Spencer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Florence Malowa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - David McCarty
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
- The Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jacob Phulusa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Beatrice Chinoko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Sylvester Kaimba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Lucy Keyala
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Peter Mandala
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Mercy Mkandawire
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Matthew Mlongoti
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Bright Mnesa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Albert Mukatipa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Rhona Mijumbi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
- The Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Hendry R. Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Marc Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | | | - David Oxborough
- Liverpool Centre for Cardiovascular Sciences, Liverpool John Moores University, Liverpool, England, UK
| | - Eve Worrall
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Paul Dark
- Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, England, UK
| | - Stephen B. Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Collaborators
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
- The Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Royal United Hospitals Bath NHS Foundation Trust, Bath, England, UK
- Liverpool Centre for Cardiovascular Sciences, Liverpool John Moores University, Liverpool, England, UK
- Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, England, UK
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Mwaba C, Munsaka S, Bvulani B, Mwakazanga D, Chiluba BC, Fitzwanga K, Mpabalwani E. Malaria is the leading cause of acute kidney injury among a Zambian paediatric renal service cohort retrospectively evaluated for aetiologies, predictors of the need for dialysis, and outcomes. PLoS One 2023; 18:e0293037. [PMID: 37878602 PMCID: PMC10599569 DOI: 10.1371/journal.pone.0293037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Whilst malaria is a prominent aetiology associated with acute kidney injury (AKI) in many parts of Africa, a shift in the traditional AKI aetiologies has been witnessed in sections of the continent. Additionally, limited access to dialysis worsens patient outcomes in these low-resource settings. This retrospective cross-sectional study aimed to determine the associated aetiologies, predictors of need for dialysis and malaria-associated AKI (MAKI), and outcomes of AKI and dialysis among children evaluated by the renal service in Lusaka, Zambia. METHODS The study sampled all children aged 16 years or below, diagnosed with AKI between 2017 and 2021, by the renal unit at the University Teaching Hospitals- Children's Hospital (UTH-CH), and retrospectively abstracted their records for exposures and outcomes. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Frequency and percentage distributions were used to describe the occurrence of AKI aetiologies and treatment outcomes. Predictors of the need for dialysis, MAKI, and poor treatment outcome were identified by using multivariable logistic regression models. RESULTS A total of 126 children diagnosed with AKI were included in this study. Malaria was the most frequent aetiology of AKI(61.1% (77/126, 95% Confidence Interval (CI): 52.0%-69.7%)). Of the 126 children with AKI, 74.6% (94) underwent dialysis. Predictors of the need for dialysis were oliguria (p = 0.0024; Odds ratio (OR) = 7.5, 95% CI: 2.1-27.7) and anuria (p = 0.0211; OR = 6.4, 95% CI = 1.3, 30.7). A fifth (18.3%, 23/126) of the children developed chronic kidney disease (CKD), 5.6% (7/126) died and, a year later, 77% (97/126) were lost to follow-up. CONCLUSION At UTH-CH, malaria is the most frequent aetiology among children with AKI undergoing dialysis and children from low-medium malaria incidence areas are at risk; a considerable proportion of children with AKI need dialysis and Tenchoff catheter use in AKI is advocated.
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Affiliation(s)
- Chisambo Mwaba
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospitals-Children’s Hospital, Lusaka, Zambia
| | - Sody Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Bruce Bvulani
- Department of Paediatric Surgery, University Teaching Hospitals-Adult Hospital, Lusaka, Zambia
| | - David Mwakazanga
- Department of Public Health, Tropical Diseases Research Centre, 6-7 Floors Ndola Teaching Hospital, Ndola, Zambia
| | - Brian Chanda Chiluba
- Department of Biostatistics and Epidemiology, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Kaiser Fitzwanga
- Department of Paediatrics, Intensive Care Unit, Windhoek Central Hospital, Windhoek, Namibia
| | - Evans Mpabalwani
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospitals-Children’s Hospital, Lusaka, Zambia
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4
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Spencer SA, Rylance J, Quint JK, Gordon SB, Dark P, Morton B. Use of hospital services by patients with chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis. Bull World Health Organ 2023; 101:558-570G. [PMID: 37638357 PMCID: PMC10452942 DOI: 10.2471/blt.22.289597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 06/07/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in countries in sub-Saharan Africa. Methods We systematically searched MEDLINE®, Embase®, Global Index Medicus, Global Health and SciELO for publications reporting on patient cohorts recruited between 1 January 2010 and 12 May 2023. We included articles reporting prevalence of pre-specified chronic diseases within unselected acute care services (emergency departments or medical inpatient settings). No language restrictions were applied. We generated prevalence estimates using random-effects meta-analysis alongside 95% confidence intervals, 95% prediction intervals and I2 statistics for heterogeneity. To explore associations with age, sex, country-level income status, geographical region and risk of bias, we conducted pre-specified meta-regression, sub-group and sensitivity analyses. Findings Of 6976 identified studies, 61 met the inclusion criteria, comprising data from 20 countries and 376 676 people. None directly reported multimorbidity, but instead reported prevalence for individual conditions. Among medical admissions, the highest prevalence was human immunodeficiency virus infection (36.4%; 95% CI: 31.3-41.8); hypertension (24.4%; 95% CI: 16.7-34.2); diabetes (11.9%; 95% CI: 9.9-14.3); heart failure (8.2%; 95% CI: 5.6-11.9); chronic kidney disease (7.7%; 95% CI: 3.9-14.7); and stroke (6.8%; 95% CI: 4.7-9.6). Conclusion Among patients seeking hospital care in sub-Saharan Africa, multimorbidity remains poorly described despite high burdens of individual chronic diseases. Prospective public health studies of multimorbidity burden are needed to generate integrated and context-specific health system interventions that act to maximize patient survival and well-being.
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Affiliation(s)
- Stephen A Spencer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, England
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, England
| | - Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
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5
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Kumar V, Jha V. Community acquired and hospital acquired AKI - two diseases divided by a common definition. Curr Opin Nephrol Hypertens 2023; 32:386-393. [PMID: 36866804 PMCID: PMC7616046 DOI: 10.1097/mnh.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is common across the world. AKI that is acquired in the community (community acquired AKI, CA-AKI) has different risk factors, epidemiological profile, presentation and impact as compared to hospital acquired AKI (HA-AKI). Hence, similar approaches to tackle CA-AKI and HA-AKI might not work. This review highlights the important differences between the two entities that have a bearing on the overall approach to the conditions and how CA-AKI has been overshadowed by HA-AKI in research, diagnosis and treatment recommendations and clinical practice guidelines. RECENT FINDINGS The overall burden of AKI is disproportionately more in low and low-middle income countries. The Global Snapshot study of International Society of Nephrology's (ISN) AKI 0by25 program has shown that CA-AKI is the dominant form in these settings. Its profile and outcomes vary with geographical and socio-economic characteristics of the regions where it develops. The current clinical practice guidelines for AKI align more with HA-AKI than CA-AKI, and fail to capture the complete spectrum of CA-AKI as well as its impact. The ISN AKI 0by25 studies have uncovered the circumstantial compulsions in defining and assessing AKI in these settings and shown feasibility of community-based interventions. SUMMARY Efforts are needed to better understand CA-AKI in low-resource settings and develop context specific guidance and interventions. A multidisciplinary, collaborative approach with representation from community would be required.
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Affiliation(s)
- Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Vivekanand Jha
- George Institute for Global Health UNSW, New Delhi
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
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6
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Cullis B, Calice da Silva V, McCulloch M, Ulasi I, Wijewickrama E, Iyengar A. Access to Dialysis for Acute Kidney Injury in Low-Resource Settings. Semin Nephrol 2023; 42:151313. [PMID: 36821914 DOI: 10.1016/j.semnephrol.2023.151313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Acute kidney injury (AKI) is estimated to occur in approximately 13.3 million patients per year with an estimated mortality of 1.7 million. Approximately 85% of cases occur in low-resource settings where access to kidney replacement therapy (KRT) may be limited or nonexistent. The true extent of AKI, including access to KRT in developing countries, is largely unknown because appropriate systems are not in place to detect AKI or report it. Barriers to provision of KRT in low-resource settings revolve around systems management and funding, however, there also are region-specific issues. This review focuses on the epidemiology, obstacles, and solutions to improving access to KRT for AKI.
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Affiliation(s)
- Brett Cullis
- Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa; Renal Unit, Hilton Life Hospital, Hilton, South Africa.
| | | | - Mignon McCulloch
- Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
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7
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Lertussavavivat T, Kulvichit W, Peerapornratana S, Lumlertgul N, Bhumitrakul J, Tungsanga K, Eiam-Ong S, Avihingsanon Y, Kellum JA, Srisawat N. The epidemiology and long-term outcomes of acute kidney disease in a resource-limited setting. J Nephrol 2022; 35:2283-2292. [PMID: 35445946 DOI: 10.1007/s40620-022-01328-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The concept of acute kidney disease (AKD) implies kidney damage that results in a significant decrease in glomerular filtration rate, including acute kidney injury (AKI), but that is not persistent enough to meet the criteria of chronic kidney disease (CKD). While a few studies have shown associations between AKD and the risk of adverse outcomes, there is still a lack of evidence from resource-limited settings. METHODS All hospitalized patients at the study hospital during 2017 were retrospectively reviewed. Diagnosis of AKI, AKD, and CKD was based on the diagnostic algorithm proposed by KDIGO. Patients were followed up for 2 years to determine their risks of mortality, development of CKD, and progression of pre-existing CKD. RESULTS A total of 9800 patients were included in the analysis, 26.1% of whom had pre-existing CKD, while AKD without AKI was found in 8% and 7% of individuals with and without pre-existing CKD, respectively. Patients with AKD without AKI were associated with higher in-hospital mortality than those without pre-existing CKD [adjusted hazard ratio (aHR) of 2.50; 95% CI 1.43, 4.37] and with pre-existing CKD (aHR 1.79; 95% CI 1.16, 2.76). The incidence of new CKD was higher in the group of AKD without AKI than in the AKI group (34.8 vs. 14.7%). CONCLUSION In a resource-limited setting, AKD is associated with short- and long-term mortality and CKD progression, especially in individuals with pre-existing CKD.
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Affiliation(s)
- Tanat Lertussavavivat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Win Kulvichit
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Sadudee Peerapornratana
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Jom Bhumitrakul
- King's College London GKT School of Medical Education, King's College London, London, England, UK
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - John A Kellum
- Department of Critical Care Medicine, The Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand. .,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. .,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand. .,Department of Critical Care Medicine, The Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Academy of Science, Royal Society of Thailand, Bangkok, Thailand. .,Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand. .,Excellence Center for Critical Care Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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8
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Du ZX, Chang FQ, Wang ZJ, Zhou DM, Li Y, Yang JH. A risk prediction model for acute kidney injury in patients with pulmonary tuberculosis during anti-tuberculosis treatment. Ren Fail 2022; 44:625-635. [PMID: 35373713 PMCID: PMC8986302 DOI: 10.1080/0886022x.2022.2058405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is not a rare complication during anti-tuberculosis treatment in some patients with pulmonary tuberculosis (PTB). We aimed to develop a risk prediction model for early recognition of patients with PTB at high risk for AKI during anti-TB treatment. METHODS This retrospective cohort study assessed the clinical baseline, and laboratory test data of 315 inpatients with active PTB who were screened for predictive factors from January 2019 to June 2020. The elements were analyzed by logistic regression analysis. A nomogram was established by the results of the logistic regression analysis. The prediction model discrimination and calibration were evaluated by the concordance index (C-index), ROC curve, and Hosmer-Lemeshow analysis. RESULTS A total of 315 patients with PTB were enrolled (67 patients with AKI and 248 patients without AKI). Seven factors, including microalbuminuria, hematuria, cystatin-C (CYS-C), albumin (ALB), creatinine-based estimated glomerular filtration rates (eGFRs), body mass index (BMI), and CA-125 were acquired to develop the predictive model. According to the logistic regression, microalbuminuria (OR = 3.038, 95%CI 1.168-7.904), hematuria (OR = 3.656, 95%CI 1.325-10.083), CYS-C (OR = 4.416, 95%CI 2.296-8.491), and CA-125 (OR = 3.93, 95%CI 1.436-10.756) were risk parameter, while ALB (OR = 0.741, 95%CI 0.650-0.844) was protective parameter. The nomogram demonstrated good prediction in estimating AKI (C-index= 0.967, AUC = 0.967, 95%CI (0.941-0.984), sensitivity = 91.04%, specificity = 93.95%, Hosmer-Lemeshow analysis SD = 0.00054, and quantile of absolute error = 0.049). CONCLUSIONS Microalbuminuria, hematuria, ALB reduction, elevated CYS-C, and CA-125 are predictive factors for the development of AKI in patients with PTB during anti-TB treatments. The predictive nomogram based on five predictive factors is achieved good risk prediction for AKI during anti-TB treatments.
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Affiliation(s)
- Zhi Xiang Du
- Department of Infectious Diseases, Taizhou People's Hospital, Taizhou, China
| | - Fang Qun Chang
- Department of Geriatric respiratory and critical illness, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zi Jian Wang
- Department of Infectious Diseases, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Da Ming Zhou
- Department of Infectious Diseases, Taizhou People's Hospital, Taizhou, China
| | - Yang Li
- Department of Infectious Diseases, Taizhou People's Hospital, Taizhou, China
| | - Jiang Hua Yang
- Department of Infectious Diseases, Yijishan Hospital, Wannan Medical College, Wuhu, China
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9
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Kasongo N, Siziya S, Banda J. Clinical profile and predictors of renal failure in emergency department patients at a tertiary level hospital, a cross sectional study. Afr J Emerg Med 2022; 12:456-460. [PMID: 36397992 PMCID: PMC9664393 DOI: 10.1016/j.afjem.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Our study was able to highlight the profile of patients at risk of renal failure who were likely older, hypertensive, oliguric and with low hemoglobin compared to those without. This Knowledge can help care givers and policy makers to pay particular attention and institute interventions targeted at treating non communicable diseases (that lead to renal failure) and infections there by reducing progressing to renal failure and end stage renal disease with need for renal replacement therapy. In addition, it also showed that simple bedside tests like dip stick urinalysis and urine output monitoring are key in surveillance of renal failure.
Background Since establishment of the emergency departments (ED) in the country, there is lack of information on clinical profile of patients admitted to the ED and predictors of renal failure in these patients. Renal failure is prevalent in critical patients and a cause of significant mortality and morbidity. The aim of this study was to assess the clinical profile and predictors of renal failure in admissions to the ED. Methods This was a cross-sectional study that was conducted at a tertiary level hospital in Zambia from January to December, 2019 among admissions to the ED after ethical approval. The primary outcome of the study was to describe the clinical profile of admissions to the ED and proportion of renal failure defined as estimated glomerular filtration rate (eGFR) < 60 mls/1.72 m2 Results The final analysis includes 152 patients, 7 excluded for missing key data. The median age was 43.5 years (IQR 32.5-59.5) and 94.7% of patients were medical. Nearly 70.0% of the patients were triaged as emergency (red) or very urgent (orange). The reason for admission to the ED were sepsis and/or sepsis shock in 25.0%, diabetic hyperglycaemia emergencies in 20.0%, hypertensive crisis in 10.5%, respiratory failure (9.9%), severe malaria (7.9%) and poisoning (5.0%). The prevalence of renal failure was 36.1% and proteinuria was observed in 23.0%. Oliguria and hypertension were 5.9-fold and 1.7-fold independent predictors of renal failure in the ED. Patients with renal failure were likely older, hypertensive, oliguric and anaemic compared to those without. During admission to the ED, 19.1% died. Conclusion Sepsis and diabetic and hypertensive emergencies accounted for nearly half of ED admissions. Hypertension and oliguria were key predictors of renal failure. Early diagnosis, management and follow-up of hypertension including urine output monitoring for high-risk patients is key in surveillance and prevention of renal failure.
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Affiliation(s)
- Nancy Kasongo
- Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
- Copperbelt University School of Medicine, Ndola, Zambia
- Corresponding author.
| | - Seta Siziya
- Copperbelt University School of Medicine, Ndola, Zambia
| | - Justor Banda
- Department of Internal Medicine, Ndola Teaching Hospital, Ndola, Zambia
- Department of Medical Sciences, University of Namibia, Namibia
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Carey LI, Kaimba S, Nyirenda S, Chetcuti K, Joekes E, Henrion MYR, Rylance J. Prospective cohort study to identify prevalence, risk factors and outcomes of infection associated kidney disease in a regional hospital in Malawi. BMJ Open 2022; 12:e065649. [PMID: 36442901 PMCID: PMC9710333 DOI: 10.1136/bmjopen-2022-065649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Acute kidney injury (AKI) is a common and severe complication of community acquired infection, but data on impact in sub-Saharan Africa (SSA) are lacking. We determined prevalence, risk factors and outcomes of infection associated kidney disease in adults in Malawi. DESIGN A prospective cohort study of adults admitted to hospital with infection, from February 2021 to June 2021, collecting demographic, clinical, laboratory and ultrasonography data. SETTING Adults admitted to a regional hospital in Southern Region, Malawi. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were prevalence of kidney disease and mortality by Cox proportional hazard model. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes were risk factors for AKI identified by logistic regression and prevalence of chronic kidney disease at 3 months. RESULTS We recruited 101 patients presenting to hospital with infection. Median age was 38 years (IQR: 29-48 years), 88 had known HIV status of which 53 (60%) were living with HIV, and of these 42 (79%) were receiving antiretroviral therapy. AKI was present in 33/101 at baseline, of which 18/33 (55%) cases were severe (KDIGO stage 3). At 3 months, 28/94 (30%) participants had died, while 7/61 (11%) of survivors had chronic kidney disease. AKI was associated with older age (age: 60 years vs 40 years, OR: 3.88, 95% CI 1.82 to 16.64), and HIV positivity (OR: 4.08, 95% CI 1.28 to 15.67). Living with HIV was independently associated with death (HR: 3.97, 95% CI 1.07 to 14.69). CONCLUSIONS Kidney disease is common among hospitalised adults with infection in Malawi, with significant kidney impairment identified at 3 months. Our study highlights the difficulty in diagnosing acute and chronic kidney disease, and the need for more accurate methods than creatinine based estimated glomerular filtration rate (eGFR) equations for populations in Africa. Patients with kidney impairment identified in hospital should be prioritised for follow-up.
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Affiliation(s)
- Laura Isobel Carey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sylvester Kaimba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Saulos Nyirenda
- Department of Medicine, Zomba Central Hospital, Zomba, Malawi
| | - Karen Chetcuti
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Worldwide Radiology, Liverpool, UK
| | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Worldwide Radiology, Liverpool, UK
| | - Marc Yves Romain Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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11
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Gursu M, Yegenaga I, Tuglular S, Dursun B, Bek SG, Bardak S, Onan E, Demir S, Derici U, Dogukan A, Sevinc M, Kocyigit I, Altun E, Haras AB, Altiparmak MR, Tonbul HZ. Acute kidney injury in Turkey: epidemiological characteristics, etiology, clinical course, and prognosis. BMC Nephrol 2022; 23:326. [PMID: 36199011 PMCID: PMC9533605 DOI: 10.1186/s12882-022-02933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to evaluate the etiologies, comorbidities, and outcomes of acute kidney injury (AKI) in Turkey and determine any potential differences among different geographical parts of the country. Methods This prospective observational study was conducted by the Acute Kidney Injury Working Group of the Turkish Society of Nephrology. Demographical and clinical data of patients with AKI at the time of diagnosis and at the 1st week and 1st, 3rd, and 6th months of diagnosis were evaluated to determine patient and renal survival and factors associated with patient prognosis. Results A total of 776 patients were included (54.7% male, median age: 67 years). Prerenal etiologies, including dehydration, heart failure, and sepsis, were more frequent than other etiologies. 58.9% of the patients had at least one renal etiology, with nephrotoxic agent exposure as the most common etiology. The etiologic factors were mostly similar throughout the country. 33.6% of the patients needed kidney replacement therapy. At the 6th month of diagnosis, 29.5% of the patients had complete recovery; 34.1% had partial recovery; 9.5% developed end-stage kidney disease; and 24.1% died. The mortality rate was higher in the patients from the Eastern Anatolian region; those admitted to the intensive care unit; those with prerenal, renal, and postrenal etiologies together, stage 3 AKI, sepsis, cirrhosis, heart failure, and malignancy; those who need kidney replacement therapy; and those without chronic kidney disease than in the other patients. Conclusion Physicians managing patients with AKI should be alert against dehydration, heart failure, sepsis, and nephrotoxic agent exposure. Understanding the characteristics and outcomes of patients with AKI in their countries would help prevent AKI and improve treatment strategies.
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Affiliation(s)
- Meltem Gursu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Itir Yegenaga
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Maltepe University, Istanbul, Turkey
| | - Serhan Tuglular
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Belda Dursun
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Pamukkale University, Denizli, Turkey
| | - Sibel Gokcay Bek
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Kocaeli University, Kocaeli, Turkey
| | - Simge Bardak
- Department of Internal Medicine, Division of Nephrology, Batman State Hospital, Batman, Turkey
| | - Engin Onan
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Cukurova University, Adana, Turkey
| | - Serap Demir
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Mersin University, Mersin, Turkey
| | - Ulver Derici
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Gazi University, Ankara, Turkey
| | - Ayhan Dogukan
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Firat University, Elazig, Turkey
| | - Mustafa Sevinc
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ismail Kocyigit
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Erciyes University, Kayseri, Turkey
| | - Eda Altun
- Department of Internal Medicine, Division of Nephrology, Golcuk State Hospital, Kocaeli, Turkey
| | - Ali Burak Haras
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Halil Zeki Tonbul
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Meram University, Konya, Turkey
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12
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Kahindo CK, Mukuku O, Wembonyama SO, Tsongo ZK. Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature. Int J Nephrol 2022; 2022:5621665. [PMID: 35342649 PMCID: PMC8941586 DOI: 10.1155/2022/5621665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) is a complex condition that can occur in both community and hospital settings and has many aetiologies. These aetiologies may be infectious, toxic, surgical, or related to the different management methods. Although it is a major public health problem worldwide, it must be emphasised that both its incidence and mortality rate appear to be very high in sub-Saharan African (SSA) countries compared to developed countries. The profile of AKI is very different from that of more developed countries. There are no reliable statistics on the incidence of AKI in SSA. Infections (malaria, HIV, diarrhoeal, and other diseases), nephrotoxins, and obstetric and surgical complications are the main aetiologies in Africa. The management of AKI is costly and associated with high rates of prolonged hospitalisation and in-hospital mortality.
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Affiliation(s)
- Charles Kangitsi Kahindo
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Clinique Internationnale de Medecine Avancee au Kivu, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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13
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Bjornstad EC, Smith ZH, Muronya W, Munthali CK, Mottl AK, Marshall SW, Golightly YM, Gibson K, Charles A, Gower EW. High risk of acute kidney injury in Malawian trauma patients: a prospective observational cohort study. BMC Nephrol 2021; 22:354. [PMID: 34711197 PMCID: PMC8552973 DOI: 10.1186/s12882-021-02564-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023] Open
Abstract
Background Trauma is a common cause of acute kidney injury (AKI). Yet little data exist regarding trauma-related-AKI in low-resourced settings, where the majority of deaths from AKI and trauma occur. We prospectively evaluated epidemiology of AKI in hospitalized Malawian trauma patients. Methods AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes (KDIGO) criteria. Those with AKI were followed up 3–6 months later to determine persistent kidney abnormalities. We calculated univariate statistics with Wilcoxon rank sum tests, Fisher’s exact, and chi-square tests to compare those with and without AKI. Multivariate log-risk regression modelling was used to determine risk ratios (RR) and 95% confidence intervals (CI) for AKI development. Results Of 223 participants, 14.4% (n = 32) developed AKI. Most patients were young (median age 32) males (n = 193, 86.5%) involved in road traffic injuries (n = 120, 53.8%). After adjusting for confounders, those with severe anemia during their admission were 1.4 times (RR 1.4, 95% CI 1.1–1.8) more likely to develop AKI than those without. Overall mortality was 7.6% (n = 17), and those who developed AKI were more likely to die than those who did not (18.8% vs 5.6%, p-value = 0.02). Almost half of those with AKI (n = 32) either died (n = 6) or had persistent kidney dysfunction at follow-up (n = 8). Conclusion In one of the few African studies on trauma-related AKI, we found a high incidence of AKI (14.4%) in Malawian trauma patients with associated poor outcomes. Given AKI’s association with increased mortality and potential ramifications on long-term morbidity, urgent attention is needed to improve AKI-related outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02564-y.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 516, Birmingham, AL, 35233, USA.
| | - Zachary H Smith
- Univeristy of North Carolina Project Malawi, Lilongwe, Malawi.,Division of Pediatric Critical Care Medicine, Stanford University School of Medicine, Stanford, USA
| | - William Muronya
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Charles K Munthali
- Department of Medicine, Renal Unit, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Amy K Mottl
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Stephen W Marshall
- University of North Carolina Injury Prevention Research Center, Chapel Hill, USA.,Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- University of North Carolina Injury Prevention Research Center, Chapel Hill, USA.,Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Keisha Gibson
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.,Malawi Surgical Initiative, Lilongwe, Malawi
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
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14
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Jaryal A, Vikrant S, Gupta D. Epidemiology and outcomes of dialysis requiring acute kidney injury: A single-center study. Ther Apher Dial 2021; 26:594-600. [PMID: 34538021 DOI: 10.1111/1744-9987.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Acute kidney injury (AKI) is a common diagnosis in hospitalized patients. Dialysis requiring AKI (AKI-D) is associated with adverse outcomes. This study aims to know the clinical profile and short-term outcomes at 3 months, in patients with AKI-D, at our center. METHODS A prospective observational study was done of all the patients admitted with AKI-D for 2 years, from July 2018 to June 2020. We recorded clinical parameters at baseline and postdischarge follow-up at 3 months. RESULTS One hundred twenty-eight patients had AKI-D over 2 years. Then, 116 (90.6%) patients had community-acquired AKI (CAAKI), and 12 (9.4%) patients had hospital-acquired AKI. The underlying causes of AKI-D were: toxins in 48 (37.5%), sepsis in 31 (24.2%), acute kidney disease in 15 (11.7%), acute gastroenteritis (AGE) in 9 (7%), and cardiogenic shock in 7 (5.5%) patients. The mean values of intact parathyroid hormone (available in 32% of patients) were 268 pg/mL. Intermittent hemodialysis was the commonest mode of dialysis (85.2%). A kidney biopsy was done in 23 (18%) patients. The most common diagnosis on kidney biopsy was glomerulonephritis (GN) in 12 patients (crescentic GN-9 and IgA nephropathy-3), followed by acute tubule-interstitial nephritis in 6 patients. In-hospital mortality was 29.7%. Overall, 39% regained serum creatinine in the normal range at 3 months, 36.7% died, 14.1% reached chronic kidney disease (CKD), 7.8% lost to follow-up, and 2.3% had reached end-stage renal disease. CONCLUSION The majority of AKI-D at our center was CAAKI. A significant chunk of AKI-D (68.7%) was caused by preventable causes like toxins, sepsis, and AGE. Dysregulation of mineral metabolism was conspicuous. In chemical toxin vs. biological toxins and undifferentiated sepsis vs. the identifiable cause of sepsis, formers had significantly more in-hospital mortality than the latter ones. AKI-D is associated with high in-hospital mortality, total mortality, and risk of progression to CKD at 3 months.
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Affiliation(s)
- Ajay Jaryal
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Dalip Gupta
- Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Reis M, Salvador P, Ventura A, Beça S, Gomes AM, Fernandes JC, Dias VP. Community-Acquired Acute Kidney Injury at Hospital Admission: What Happens One Year After? ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Abebe A, Kumela K, Belay M, Kebede B, Wobie Y. Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study. Sci Rep 2021; 11:15672. [PMID: 34341369 PMCID: PMC8329200 DOI: 10.1038/s41598-021-94946-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
Acute kidney injury (AKI) is a major global public health problem. It is expensive to manage and associated with a high rate of prolonged hospitalization and in-hospital mortality. Little is known about the burden of acute kidney injury in moderate to low-income countries. We aim to assess predictors of in-hospital mortality among AKI patients admitted to the medical ward. We prospectively identified patients meeting kidney disease improving global outcomes (KIDGO) AKI definitions from April to August 2019. Patients with underlying CKD and patients hospitalized for less than 48 h were excluded. The Cox regression model was fitted to identify predictors of mortality and statistical significance was considered at the p-value of less than 0.05. A total of 203 patients were enrolled over 5 months. Out of this, 121(59.6%) were males, 58(28.6%) were aged greater than 60 years, and 141(69.5%) had community-acquired acute kidney injury. The most common causes of AKI were Hypovolemia 99(48.77%), Glomerulonephritis 51(25.11%), and sepsis 32(15.79%). The overall in-hospital mortality rate was 12.8%. Stage 3 AKI (AHR = 9.61, 95% CI 1.17-28.52, p = 0.035), duration of AKI (AHR = 7.04, 95% CI 1.37-36.08, p = 0.019), length of hospital stay (AHR = 0.19, 95% CI 0.05-0.73, p = 0.012), and hyperkalemia (AHR = 3.61, 95% CI 1.12-11.71, p = 0.032) were significantly associated with in-hospital mortality. There is a high rate of acute kidney injury-related in-hospital mortality in adult patients admitted to the medical ward. The severity of AKI, hyperkalemia duration of AKI, and a short length of hospital stay were predictors of 30-days in-hospital mortality. Most of the causes of AKI are preventable and patients may benefit from early identification and treatment of these reversible causes.
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Affiliation(s)
- Abinet Abebe
- School of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia.
| | - Kabaye Kumela
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Bezie Kebede
- School of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia
| | - Yohannes Wobie
- School of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia
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17
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Batte A, Berrens Z, Murphy K, Mufumba I, Sarangam ML, Hawkes MT, Conroy AL. Malaria-Associated Acute Kidney Injury in African Children: Prevalence, Pathophysiology, Impact, and Management Challenges. Int J Nephrol Renovasc Dis 2021; 14:235-253. [PMID: 34267538 PMCID: PMC8276826 DOI: 10.2147/ijnrd.s239157] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023] Open
Abstract
Acute kidney injury (AKI) is emerging as a complication of increasing clinical importance associated with substantial morbidity and mortality in African children with severe malaria. Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI, an estimated 24–59% of African children with severe malaria have AKI with most AKI community-acquired. AKI is a risk factor for mortality in pediatric severe malaria with a stepwise increase in mortality across AKI stages. AKI is also a risk factor for post-discharge mortality and is associated with increased long-term risk of neurocognitive impairment and behavioral problems in survivors. Following injury, the kidney undergoes a process of recovery and repair. AKI is an established risk factor for chronic kidney disease and hypertension in survivors and is associated with an increased risk of chronic kidney disease in severe malaria survivors. The magnitude of the risk and contribution of malaria-associated AKI to chronic kidney disease in malaria-endemic areas remains undetermined. Pathways associated with AKI pathogenesis in the context of pediatric severe malaria are not well understood, but there is emerging evidence that immune activation, endothelial dysfunction, and hemolysis-mediated oxidative stress all directly contribute to kidney injury. In this review, we outline the KDIGO bundle of care and highlight how this could be applied in the context of severe malaria to improve kidney perfusion, reduce AKI progression, and improve survival. With increased recognition that AKI in severe malaria is associated with substantial post-discharge morbidity and long-term risk of chronic kidney disease, there is a need to increase AKI recognition through enhanced access to creatinine-based and next-generation biomarker diagnostics. Long-term studies to assess severe malaria-associated AKI’s impact on long-term health in malaria-endemic areas are urgently needed.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Zachary Berrens
- Department of Pediatrics, Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kristin Murphy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ivan Mufumba
- CHILD Research Laboratory, Global Health Uganda, Kampala, Uganda
| | | | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Abebe A, Kebede B, Wobie Y. Clinical Profile and Short-Term Outcomes of Acute Kidney Injury in Patients Admitted to a Teaching Hospital in Ethiopia: A Prospective Study. Int J Nephrol Renovasc Dis 2021; 14:201-209. [PMID: 34239318 PMCID: PMC8259934 DOI: 10.2147/ijnrd.s318037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication in hospitalized patients and a marker for poor patient outcomes. It is associated with a high risk of mortality and other short- and long-term adverse outcomes. We aim to assess the clinical profile and short-term outcomes of acute kidney injury in adult patients admitted to the medical ward. Methods A hospital-based prospective observational study was conducted from October 2019 to January 2020. All adult patients diagnosed as AKI using kidney disease improving global outcomes (KIDGO) criteria were included in the study and prospectively followed to document the short-term outcomes. Outcomes and their predictors were determined using multivariate logistic regression. P-value less than 0.05 was taken as statistically significant. Results A total of 160 patients were included in the study. Out of this, 96 (60%) were males, 118 (74%) had community-acquired AKI, and 51 (32%) had stage 3 AKI. Common causes of AKI were hypovolemia 62 (39%) and sepsis 35 (22%). Hypertension 69 (43%) and heart failure 50 (31%) were common underlying comorbidities. Fifty-six (35%) patients developed systemic complications, 98 (61.2%) had persistent AKI, 136 (85%) had prolonged length of hospital stay, and 18 (11%) were readmitted to the hospital. The presence of AKI-related complication (AOR=2.7, 95% CI: 1.14–6.58, p=0.024), and duration of AKI (AOR=9.7, 95% CI: 2.56–36.98, p=0.001) were factors associated with prolonged length of hospital stay. Preexisting CKD (AOR=3.6, 95% CI: 1.02–13.14, p=0.035) and stage 3 AKI (AOR=2.1, 95% CI: 1.6–3.57, p=0.04) were factors associated with 30-day hospital readmission. Conclusion Hypovolemia and infections were the primary causes of AKI. Complications, prolonged length of hospital stay, persistent AKI, and rehospitalization were poor short-term outcomes of AKI. Early diagnosis and timely management of AKI particularly in high-risk hospitalized patients, and post-AKI care including management of comorbidities for AKI survivors should improve these poor short-term outcomes.
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Affiliation(s)
- Abinet Abebe
- Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Mizan Tepi University, Mizan, Ethiopia
| | - Bezie Kebede
- Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Mizan Tepi University, Mizan, Ethiopia
| | - Yohannes Wobie
- Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Mizan Tepi University, Mizan, Ethiopia
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19
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Evans RDR, Hemmila U, Mzinganjira H, Mtekateka M, Banda E, Sibale N, Kawale Z, Phiri C, Dreyer G, Calice-Silva V, Raimann JG, Levin N, Pecoits-Filho R, Mehta R, Macedo E. Diagnostic performance of a point-of-care saliva urea nitrogen dipstick to screen for kidney disease in low-resource settings where serum creatinine is unavailable. BMJ Glob Health 2021; 5:bmjgh-2020-002312. [PMID: 32371573 PMCID: PMC7228485 DOI: 10.1136/bmjgh-2020-002312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/11/2020] [Accepted: 04/07/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Kidney disease is prevalent in low-resource settings worldwide, but tests for its diagnosis are often unavailable. The saliva urea nitrogen (SUN) dipstick is a laboratory and electricity independent tool, which may be used for the detection of kidney disease. We investigated the feasibility and performance of its use in diagnosing kidney disease in community settings in Africa. METHODS Adult patients at increased risk of kidney disease presenting to three community health centres, a rural district hospital and a central hospital in Malawi were recruited between October 2016 and September 2017. Patients underwent concurrent SUN and creatinine testing at enrolment, and at 1 week, 1 month, 3 months and 6 months thereafter. RESULTS Of 710 patients who presented at increased risk of kidney disease, 655 (92.3%) underwent SUN testing at enrolment, and were included (aged 38 (29-52) years, 367 (56%) female and 333 (50.8%) with HIV). Kidney disease was present in 482 (73.6%) patients and 1479 SUN measurements were made overall. Estimated glomerular filtration rate (eGFR) correlated with SUN (r=-0.39; p<0.0001). The area under the receiver operating characteristics curve was 0.61 for presenting SUN to detect acute or chronic kidney disease, and 0.87 to detect severe (eGFR <15 mL/min/1.73 m2) kidney disease (p<0.0001; sensitivity 82.3%, specificity 81.8%, test accuracy 81.8%). In-hospital mortality was greater if enrolment SUN was elevated (>test pad #1) compared with patients with non-elevated SUN (p<0.0001; HR 3.3 (95% CI 1.7 to 6.1). CONCLUSIONS SUN, measured by dipstick, is feasible and may be used to screen for kidney disease in low resource settings where creatinine tests are unavailable.
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Affiliation(s)
| | - Ulla Hemmila
- Renal Medicine, Barts Health NHS Trust, London, London, UK
| | - Henry Mzinganjira
- Renal Medicine, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Mwayi Mtekateka
- Renal Medicine, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Enos Banda
- Renal Medicine, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Naomi Sibale
- Renal Medicine, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Zuze Kawale
- Renal Medicine, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Chimota Phiri
- Renal Medicine, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Gavin Dreyer
- Renal Medicine, Barts Health NHS Trust, London, London, UK
| | - Viviane Calice-Silva
- Renal Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Nathan Levin
- Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ravi Mehta
- Medicine, University of California San Diego, La Jolla, California, USA
| | - Etienne Macedo
- Medicine, University of California San Diego, La Jolla, California, USA
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20
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Jha AK, Gairola S, Kundu S, Doye P, Syed AM, Ram C, Murty US, Naidu VGM, Sahu BD. Toll-like receptor 4: An attractive therapeutic target for acute kidney injury. Life Sci 2021; 271:119155. [PMID: 33548286 DOI: 10.1016/j.lfs.2021.119155] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
Acute kidney injury (AKI) is a progressive renal complication which significantly affects the patient's life with huge economic burden. Untreated acute kidney injury eventually progresses to a chronic form and end-stage renal disease. Although significant breakthroughs have been made in recent years, there are still no effective pharmacological therapies for the treatment of acute kidney injury. Toll-like receptor 4 (TLR4) is a well-characterized pattern recognition receptor, and increasing evidence has shown that TLR4 mediated inflammatory response plays a pivotal role in the pathogenesis of acute kidney injury. The expression of TLR4 has been seen in resident renal cells, including podocytes, mesangial cells, tubular epithelial cells and endothelial cells. Activation of TLR4 signaling regulates the transcription of numerous pro-inflammatory cytokines and chemokines, resulting in renal inflammation. Therefore, targeting TLR4 and its downstream effectors could serve as an effective therapeutic intervention to prevent renal inflammation and subsequent kidney damage. For the first time, this review summarizes the literature on acute kidney injury from the perspective of TLR4 from year 2010 to 2020. In the current review, the role of TLR4 signaling pathway in AKI with preclinical evidence is discussed. Furthermore, we have highlighted several compounds of natural and synthetic origin, which have the potential to avert the renal TLR4 signaling in preclinical AKI models and have shown protection against AKI. This scientific review provides new ideas for targeting TLR4 in the treatment of AKI and provides strategies for the drug development against AKI.
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Affiliation(s)
- Ankush Kumar Jha
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - Shobhit Gairola
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - Sourav Kundu
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - Pakpi Doye
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - Abu Mohammad Syed
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - Chetan Ram
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - Upadhyayula Suryanarayana Murty
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - V G M Naidu
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India
| | - Bidya Dhar Sahu
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari PIN-781101, Assam, India.
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21
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Rudd KE, Cizmeci EA, Galli GM, Lundeg G, Schultz MJ, Papali A. Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:87-98. [PMID: 33432912 PMCID: PMC7957240 DOI: 10.4269/ajtmh.20-1242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
Current recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable.
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Affiliation(s)
- Kristina E. Rudd
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elif A. Cizmeci
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Gabriela M. Galli
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ganbold Lundeg
- Department of Critical Care and Anaesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Alfred Papali
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Critical Care and Anaesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina
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22
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Chandiraseharan VK, Kalimuthu M, Prakash TV, George T, Rajenesh A, Jayaseelan V, Sudarsanam TD. Acute kidney injury is an independent predictor of in-hospital mortality in a general medical ward: A retrospective study from a tertiary care centre in south India. Indian J Med Res 2021; 152:386-392. [PMID: 33380703 PMCID: PMC8061603 DOI: 10.4103/ijmr.ijmr_1685_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background & objectives: Acute kidney injury (AKI) has been identified as an independent risk factor for mortality in intensive care units. This retrospective study was conducted to determine the effect of AKI on in-hospital mortality in a general medical ward of a tertiary care hospital and risk factors for mortality in patients with AKI. Methods: Demographic and clinical details, and outcome data were collected from case records of patients. In all hospitalized patients, factors associated with increased in-hospital mortality, such as AKI, inotrope requirement, mechanical ventilation and primary disease were compared between patients who died during their hospital stay and those who were discharged alive. Among the hospitalized patients, who had AKI, likely predictors of in-hospital mortality were compared between dead and alive patients at discharge. Factors that were significant in univariate analysis were tested by multivariate regression analysis to identify those that independently predicted poor outcomes. Results: Of the 1150 patients admitted in a general medical ward in a year, 220 patients were identified to have AKI. In-hospital mortality rate among patients with AKI was 19.09 per cent as compared to 1.8 per cent without AKI [adjusted odds ratio (OR) 5.7 (95% CI: 1.56-20.74)]. The presence of AKI was an independent risk factor for death, with an adjusted OR of 6.0 [95% CI: 1.67-21.6]. Among patients with AKI, the presence of haematological malignancy, adjusted OR 25.86 (95% CI: 1.81-369.58), requirement of inotrope, adjusted OR 126.5 (95% CI: 19.39-825.93) and serum creatinine at admission (P<0.001) were found to be independent predictors of death. The presence of underlying chronic kidney disease and hospital-acquired AKI were not found to have an association with mortality. Interpretation & conclusions: The study showed the in-hospital mortality rate among patients with AKI in a general medical ward was 19.09 per cent. The occurrence of AKI was an independent risk factor for death, with haematological malignancy, use of vasopressors and higher serum creatinine at admission, significantly associated with death among patients with AKI. Large prospective studies need to be done to better understand the outcomes in AKI and the ways to present and manage AKI.
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Affiliation(s)
| | - Murugabharathy Kalimuthu
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Turaka Vijay Prakash
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Tina George
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Ashwin Rajenesh
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Visalakshi Jayaseelan
- Department of Biostatistics, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Thambu David Sudarsanam
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
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23
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Iram H, Ali M, Kumar V, Ejaz A, Solangi SA, Junejo AM, Solangi SA, Un Nisa N. Frequency of Risk Factors and Outcome of Hospital-Acquired Acute Kidney Injury. Cureus 2020; 12:e12001. [PMID: 33457112 PMCID: PMC7797606 DOI: 10.7759/cureus.12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the frequencies of risk factors and the ultimate outcomes of ccute kidney injury (AKI) among hospitalized patients. MATERIALS AND METHODOLOGY This prospective, observational study was carried out from September 15, 2018, to March 14, 2019. All admitted patients, both male and female, with AKI, were included. Those with chronic kidney disease (CKD), small size echogenic kidneys (on ultrasonography, performed on admission), and recent history of urological intervention were excluded from the study. All patients were assessed for etiological factors (sepsis, gastroenteritis, surgical, and obstetrical) and outcome (improved, progression to CKD, or expired). RESULTS Out of a total of 230, most patients were aged between 20-50 years with a mean age of 38.99 ± 7.61 years. Males were 144 (62.61%) and females were 86 (37.39%). About 78 (33.91%) patients were hypertensive while 65 (28.26%) were diabetic. The cause of hospital-acquired AKI was found to be sepsis in most (71.73%, n=165) of the cases, followed by gastroenteritis (10.00%, n=23), surgical (9.56%, n=22), and obstetric (8.69%, n=20) causes. When the outcome was assessed, 10 (4.35%) patients expired, 154 (66.96%) improved completely, while 66 (28.69%) progressed to CKD. CONCLUSION This study has shown that sepsis is the most common cause of AKI in patients admitted to the hospital. So we recommend that proper steps should be taken to ensure adequate hospital care for avoiding such outcomes in hospitalized patients, and further decrease mortality.
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Affiliation(s)
- Hina Iram
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Muhammad Ali
- Department of Nephrology, Fazaia Ruth Pfau Medical College, Karachi, PAK
| | - Vinod Kumar
- Department of Medicine, Sir Syed College of Medical Sciences for Girls, Karachi, PAK
| | - Ayesha Ejaz
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Shafique A Solangi
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Abdul Manan Junejo
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Noor Un Nisa
- Physiology, Jinnah Sindh Medical University, Karachi, PAK
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24
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Risk factors for development of acute kidney injury in hospitalised adults in Zimbabwe. PLoS One 2020; 15:e0241229. [PMID: 33104756 PMCID: PMC7588093 DOI: 10.1371/journal.pone.0241229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
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.
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25
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Predicting Acute Kidney Injury: A Machine Learning Approach Using Electronic Health Records. INFORMATION 2020. [DOI: 10.3390/info11080386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Acute kidney injury (AKI) is a common complication in hospitalized patients and can result in increased hospital stay, health-related costs, mortality and morbidity. A number of recent studies have shown that AKI is predictable and avoidable if early risk factors can be identified by analyzing Electronic Health Records (EHRs). In this study, we employ machine learning techniques to identify older patients who have a risk of readmission with AKI to the hospital or emergency department within 90 days after discharge. One million patients’ records are included in this study who visited the hospital or emergency department in Ontario between 2014 and 2016. The predictor variables include patient demographics, comorbid conditions, medications and diagnosis codes. We developed 31 prediction models based on different combinations of two sampling techniques, three ensemble methods, and eight classifiers. These models were evaluated through 10-fold cross-validation and compared based on the AUROC metric. The performances of these models were consistent, and the AUROC ranged between 0.61 and 0.88 for predicting AKI among 31 prediction models. In general, the performances of ensemble-based methods were higher than the cost-sensitive logistic regression. We also validated features that are most relevant in predicting AKI with a healthcare expert to improve the performance and reliability of the models. This study predicts the risk of AKI for a patient after being discharged, which provides healthcare providers enough time to intervene before the onset of AKI.
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26
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Evans RD, Phiri C. Assessing and Improving the Capacity of District Health Services in the Management of Acute Kidney Injury in Low- and Middle-Income Countries. Kidney Int Rep 2020; 5:977-979. [PMID: 32648558 PMCID: PMC7336007 DOI: 10.1016/j.ekir.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rhys D.R. Evans
- Department of Renal Medicine, University College London, London, UK
| | - Chimota Phiri
- Nephrology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
- College of Medicine, Blantyre, Malawi
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27
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Silver SA, Nadim MK, O'Donoghue DJ, Wilson FP, Kellum JA, Mehta RL, Ronco C, Kashani K, Rosner MH, Haase M, Lewington AJP. Community Health Care Quality Standards to Prevent Acute Kidney Injury and Its Consequences. Am J Med 2020; 133:552-560.e3. [PMID: 31830434 PMCID: PMC7724764 DOI: 10.1016/j.amjmed.2019.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 12/29/2022]
Abstract
As the incidence of acute kidney injury (AKI) increases, prevention strategies are needed across the health care continuum, which begins in the community. Recognizing this knowledge gap, the 22nd Acute Disease Quality Initiative (ADQI) was tasked to discuss the evidence for quality-of-care measurement and care processes to prevent AKI and its consequences in the community. Using a modified Delphi process, an international and interdisciplinary group provided a framework to identify and monitor patients with AKI in the community. The recommendations propose that risk stratification involve both susceptibilities (eg, chronic kidney disease) and exposures (eg, coronary angiography), with the latter triggering a Kidney Health Assessment. This assessment should include blood pressure, serum creatinine, and urine dipstick, followed by a Kidney Health Response to prevent AKI that encompasses cessation of unnecessary medications, minimization of nephrotoxins, patient education, and ongoing monitoring until the exposure resolves. These recommendations give community health care providers and health systems a starting point for quality improvement initiatives to prevent AKI and its consequences in the community.
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Affiliation(s)
- Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ont, Canada.
| | - Mitra K Nadim
- Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, Los Angeles
| | - Donal J O'Donoghue
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Francis P Wilson
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, Conn
| | - John A Kellum
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Penn
| | - Ravindra L Mehta
- Department of Medicine, UCSD Medical Center, University of California, San Diego
| | - Claudio Ronco
- Department of Nephrology, Dialysis, and Transplantation, International Renal Research Institute, St Bortolo Hospital, Vicenza, Italy
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville
| | - Michael Haase
- Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, & MVZ Diaverum Potsdam, Germany
| | - Andrew J P Lewington
- Renal Department, St. James's University Hospital, Leeds, UK; NIHR Diagnostic Evidence Co-operative, Leeds, UK
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28
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Igiraneza G, Dusabejambo V, Finklestein FO, Rastegar A. Challenges in the Recognition and Management of Acute Kidney Injury by Hospitals in Resource-Limited Settings. Kidney Int Rep 2020; 5:991-999. [PMID: 32647756 PMCID: PMC7336002 DOI: 10.1016/j.ekir.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/21/2020] [Accepted: 04/06/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction Acute kidney injury (AKI) is prevalent in low- and middle-income countries (LMIC) and is associated with significant morbidity and mortality, particularly among hospitalized patients. Successful strategies for the prevention and management of AKI in these countries are dependent on the capacity of primary care centers to provide optimal initial management of patients at risk for this disorder. Methods From December 2018 to February 2019, using mixed methods, we assessed hospital capacity and the knowledge of clinicians relevant to the prevention, diagnosis, and management of AKI in Rwanda. A checklist based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and clinical vignette-based assessment tool were used to assess hospital capacity and provider knowledge base, respectively. Data were analyzed using stata 13 with findings reported as simple frequencies or means with standard deviation. Multivariate analysis was used to assess factors associated with a higher knowledge score among clinicians. Results Ten hospitals and 193 health care providers from sites throughout Rwanda participated in the survey. Surveyed hospitals were equipped with basic general medical equipment but were deficient in diagnostic tools and medical supplies that would allow the diagnosis and nondialytic management of AKI. Although 20% of the hospitals could offer hemodialysis services, peritoneal dialysis services were nonexistent. With regard to knowledge base, the health care providers demonstrated significant deficiencies in the diagnosis and management of AKI. The mean knowledge score for all health providers was 6.3 (±1.5) of a maximum of 11, with a mean (±SD) score for doctors, nurses, and midwives of 6.3 ± 2.05, 6.4 ± 1.3, and 6.08 ± 1.2, respectively. On multivariate analysis, the length of clinical experience and age of the respondents were significantly associated with participants’ knowledge score. Conclusion This study documents significant barriers to providing optimal management of AKI in primary health care settings in Rwanda, a resource-limited setting. These include lack of specialized medical personnel, significant knowledge gaps among primary health care providers, suboptimal diagnostic capacity, and limited treatment options for detection and management of AKI.
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Affiliation(s)
- Grace Igiraneza
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- Yale University School of Medicine, New Haven, Connecticut, USA
- Correspondence: Grace Igiraneza, Nephrology Unit, Department of Medicine, University Teaching Hospital of Kigali, P.O. BOX 655, Kigali, Rwanda.
| | - Vincent Dusabejambo
- Department of Medicine, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | - Fredric O. Finklestein
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Asghar Rastegar
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
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29
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Bjornstad EC, Muronya W, Smith ZH, Gibson K, Mottl AK, Charles A, Marshall SW, Golightly YM, Munthali CK, Gower EW. Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study. BMC Nephrol 2020; 21:98. [PMID: 32169046 PMCID: PMC7071651 DOI: 10.1186/s12882-020-01755-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa. Methods Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI. Results We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n = 4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2–19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies. Conclusions AKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Division of Nephrology, University of Alabama Birmingham, 1600 7th Avenue South, Lowder 516, Birmingham, AL, 35233, USA. .,Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.
| | - William Muronya
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Zachary H Smith
- Univeristy of North Carolina Project Malawi, Lilongwe, Malawi.,Division of Pediatric Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Keisha Gibson
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Amy K Mottl
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.,Malawi Surgical Initiative, Lilongwe, Malawi
| | - Stephen W Marshall
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.,University of North Carolina Injury Prevention Research Center, Carrboro, NC, USA
| | - Yvonne M Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.,University of North Carolina Injury Prevention Research Center, Carrboro, NC, USA
| | - Charles K Munthali
- Department of Medicine, Renal Unit, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA
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Kachimanga C, Kamwezi R, Wroe EB, Nazimera L, Ndarama E, Thengo L, Talama GC. Screening for chronic kidney disease in rural Malawi: results from a diabetic clinic. BMC Res Notes 2019; 12:375. [PMID: 31262351 PMCID: PMC6604195 DOI: 10.1186/s13104-019-4415-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Patients with diabetes are at high risk of developing renal insufficiency and chronic kidney disease (CKD). As a result, screening for CKD is essential in diabetic patients as part of their care. This study investigated the prevalence of renal insufficiency, CKD, and correlates of CKD in diabetic patients attending Integrated Chronic Care Clinics in Neno District, Malawi. Results Of 203 diabetic patients, 148 (73%) were screened for CKD by measurement of serum creatinine and urinary protein between April 2016 and January 2019. 39.2% (n = 58) of the patients had abnormal estimated glomerular filtration rate (eGFR), as estimated by CKD Epidemiology Collaboration formula and/or ≥ 2+ urine protein. 13.5% (95% CI 8.4–20.0%, 20/148) of the patients had renal insufficiency based on eGFR of less than 60 ml/min/1.73 m2. 8.8% (95% CI 4.8–14.6%, 13/148) had CKD based on eGFR of less than 60 ml/min/1.73 m2 measured twice at least 3 months apart. In bivariate analysis, CKD was associated with older age, high systolic blood pressure and lower fasting blood sugar. Despite the low sample size, the study showed a moderately high prevalence of renal insufficiency and CKD in a rural cohort of diabetic patients in Malawi.
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Affiliation(s)
| | | | - Emily B Wroe
- Partners In Health, Post Office Box 56, Neno, Malawi
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Tecson K, Hashemi H, Afzal A, Gong T, Kale P, McCullough P. Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization. Cardiorenal Med 2019; 9:252-260. [DOI: 10.1159/000499669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives: Because patients with hospital-acquired acute kidney injury (AKI) are at risk for subsequent development of heart failure (HF) and little is known about the relation between community-acquired AKI (CA-AKI) and HF, we sought to determine if CA-AKI is a risk factor for incident HF hospitalization. Methods: We utilized Baylor Scott & White Health databases at the primary care and inpatient hospitalization levels to identify adults without a prior history of HF who had 2 or more serum creatinine measurements within 13 months in the primary care setting. We defined CA-AKI as a serum creatinine increase ≥0.3 mg/dL or ≥1.5 times the baseline for consecutive values within a 13-month period. We created a flag for de novo HF hospitalization at 90, 180, and 365 days following CA-AKI evaluation. Results: In the analyses, 210,895 unique adults were included, of whom 5,358 (2.5%) had CA-AKI. Those with CA-AKI had higher rates of comorbidities, higher rate of males (48 vs. 42%, p < 0.001), and were older (61.5 [50.3, 73.1] vs. 54.1 [42.8, 64.7] years, p < 0.001) than those who did not have CA-AKI. In total, 607 (0.3%), 833 (0.4%), and 1,089 (0.5%) individuals had an incident HF hospitalization in the 90, 180, and 365 days following the CA-AKI evaluation, respectively. After adjusting for demographic and clinical characteristics, patients with CA-AKI had >2 times the risk of de novo HF hospitalization compared with patients who did not have CA-AKI (90 days: 2.35 [1.83–3.02], p < 0.001; 180 days: 2.52 [2.04–3.13], p < 0.001; 365 days: 2.16 [1.77–2.64], p < 0.001). These multivariable models yielded strong predictive abilities, with the areas under the receiver-operating characteristic curve >0.90. Conclusion: After controlling for baseline and clinical characteristics, patients with CA-AKI were at approximately twofold the risk of de novo HF hospitalization (within 90, 180, and 365 days) compared with those who did not have CA-AKI. Hence, detecting CA-AKI may provide an opportunity for early intervention at the primary care level to possibly delay HF development.
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Calice-Silva V, Sacomboio E, Raimann JG, Evans R, Dos Santos Sebastião C, Tchivango AT, Kotanko P, Levin N, Pecoits-Filho R. Diagnostic performance of salivary urea nitrogen dipstick to detect and monitor acute kidney disease in patients with malaria. Malar J 2018; 17:477. [PMID: 30563520 PMCID: PMC6299494 DOI: 10.1186/s12936-018-2627-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication of malaria. In low resource settings, a lack of diagnostic tools and delayed treatment of malaria associated AKI lead to significant morbidity and mortality. The aim of this study was to assess the diagnostic performance of salivary urea nitrogen (SUN) dipstick to detect and monitor kidney disease [KD = AKI or acute kidney disease (AKD) without AKI] in malaria patients in Angola. Methods Patients 11–50 years old admitted with malaria at the Josina Machel (Maria-Pia) Hospital, Luanda, Angola, between 2nd March and 10th May 2016 were enrolled in this study. All participants had serum creatinine (sCr), blood urea nitrogen (BUN) and SUN dipstick tested at the time of recruitment and daily for up to 4 days. AKD without AKI refers to acute renal impairment which do not fulfilled the main criteria for AKI (increases in the baseline serum creatinine and/or decreases in urine output) according defined by the kidney disease improving global outcomes (KDIGO) guideline. Results Eight-six patients were admitted with malaria diagnosis (mean age 21.5 ± 9.4 years, 71% male) and 27 (32%) were diagnosed with KD. The mean (± SD) sCr and BUN of the KD group at admission (day 0) were 5.38 (± 5.42) and 99.4 (± 61.9) mg/dL, respectively. Three (3.5%) patients underwent haemodialysis and eight (9.3%) died within the first 4 days of hospital admission [5 (62.5%) with KD; 3 (37.5%) without kidney disease; p = 0.047]. The SUN threshold for KD diagnosis was tested pad #5 (SUN > 54 mg/dL). At this threshold, the SUN dipstick had a sensitivity of 67% and specificity of 98% to diagnose KD. The area under the receiver operating characteristics curve (ROC) for KD diagnosis on admission was 0.88 (95% CI 0.79–0.96). The SUN dipstick was most accurate at higher levels of BUN. Conclusion The SUN dipstick had reasonable sensitivity and excellent specificity when used to diagnose KD in a cohort of patients with malaria in a resource-limited setting. Given the severity of presenting illness and kidney injury, the SUN dipstick diagnostic threshold was high (test pad #5). SUN may be used to detect AKI in patients with malaria in low resources settings, thus facilitating earlier access to adequate treatment, which may improve survival. Electronic supplementary material The online version of this article (10.1186/s12936-018-2627-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Viviane Calice-Silva
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. .,Pro-Rim Foundation, Joinville, Brazil.
| | - Euclides Sacomboio
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Higher Institute of Health Sciences/Agostinho Neto University, Luanda, Angola
| | | | - Rhys Evans
- Nephrology Department, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.,University College London Centre for Nephrology, London, UK
| | | | | | - Peter Kotanko
- Research Division, Renal Research Institute, New York, USA
| | - Nathan Levin
- Icahn School of Medicine at Mount Sinai, New York, USA
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Pu L, Liu J, Luo Y, Zeng H, Guo H, Hao J, Yin N, Liu Y, Xiong H, Xiong J, Li A. Acute Kidney Injury in Chinese HIV-Infected Patients: A Retrospective Analysis from the Intensive Care Unit. AIDS Patient Care STDS 2018; 32:381-389. [PMID: 30222370 DOI: 10.1089/apc.2018.0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To describe the epidemiology, outcomes, and risk factors of acute kidney injury (AKI) among human immunodeficiency virus (HIV)-infected patients admitted to the intensive care unit (ICU).We reviewed all the HIV-infected admissions to the ICU at Beijing Ditan hospital in the time span from June 2005 to May 2017 and collected demographic, clinical, and laboratory data for our sample. AKI was diagnosed and classified according to the Kidney Disease Improving Global Outcomes (KIDIGO) criteria. We analyzed the incidence of AKI and its associated mortality. The potential risk factors for severe AKI were also investigated in this study. A total of 225 HIV-infected patients were included in the final analysis. The incidences of no-AKI, AKI stage 1, AKI stage 2, and AKI stage 3, were 46.2% (104), 19.1% (43), 8.4% (19), and 26.2% (59), respectively. By logistic regression analysis, severe AKI (stages 2-3) was an important predicator for 60-day mortality with an odds ratio of 4.234. By multivariate analysis, a high acute physiology and chronic health evaluation, version II (APACHE-II) score (p = 0.024), low albumin (p < 0.031) at the first 24-h admission ICU, shock (p = 0.013), and bloodstream infection (p = 0.006) during hospitalization were all found to be significant risk factors for severe AKI. AKI is common in HIV-infected patients admitted to the ICU, and the mortality of patients with AKI stages 2-3 is significantly higher compared with those without such conditions. A high APACHE-II score and a lower albumin level at the first 24-h admission to ICU are significant predictors of severe AKI in this specific population. Shock and bloodstream infection during hospitalization can also lead to severe AKI.
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Affiliation(s)
- Lin Pu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jingyuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yang Luo
- Department of Nephrology, Beijing Shijitan Hospital, Beijing, China
| | - Hui Zeng
- Laboratory of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hebing Guo
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingjing Hao
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ningning Yin
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yufeng Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Haofeng Xiong
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jian Xiong
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ang Li
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Evans RDR, Docherty M, Seeley A, Craik A, Mpugna M, Mann S, Dube Q, Dreyer G, Hemmila U. Incidence, Etiology, and Outcomes of Community-Acquired Acute Kidney Injury in Pediatric Admissions in Malawi. Perit Dial Int 2018; 38:405-412. [PMID: 30257995 DOI: 10.3747/pdi.2017.00253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/22/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The epidemiology of acute kidney injury (AKI) in children in sub-Sahara Africa (SSA) is poorly described. The aim of this study was to establish the incidence, etiology, and outcomes of community-acquired AKI in pediatric admissions in Southern Malawi. METHODS We conducted a prospective observational study of pediatric admissions to a tertiary hospital in Blantyre between 5 February and 30 April 2016. Children were screened for kidney disease on admission with measurement of serum creatinine and assessment of urine output. The clinical presentation, etiology, and management of children with AKI were documented. RESULTS A total of 412 patients (median age 4 years, 52.6% male, and 7.5% human immunodeficiency virus [HIV] infected) were included in the study. Forty-five patients (10.9%) had AKI (Kidney Disease: Improving Global Outcomes [KDIGO] criteria), which was stage 3 in 16 (35.6%) patients. Sepsis and hypoperfusion, most commonly due to malaria (n = 19; 42.2%), were the causes of AKI in 38 cases (84.4%). Three patients (6.7%) underwent peritoneal dialysis (PD) for AKI: 2 of them recovered kidney function, and the other one died. In-hospital mortality was 20.5% in AKI and 2.9% if no kidney disease was present (p < 0.0001). Seventeen (47.2%) patients with kidney disease had persistent kidney injury on hospital discharge. CONCLUSION Acute kidney injury occurs in 10.9% of pediatric admissions in Malawi and is primarily due to infections, particularly malaria. Acute kidney injury results in significantly increased in-hospital mortality. Urgent interventions are required to eliminate preventable causes of death in this region.
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Affiliation(s)
- Rhys D R Evans
- College of Medicine, Blantyre, Malawi .,UCL Centre for Nephrology, London, UK.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Marie Docherty
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Anna Seeley
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Alison Craik
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Martha Mpugna
- Paediatric Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Shawna Mann
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Queen Dube
- Paediatric Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Gavin Dreyer
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Nephrology, Bart's Health NHS Trust, London, UK
| | - Ulla Hemmila
- College of Medicine, Blantyre, Malawi.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Palmer D, Lawton WJ, Barrier C, Fine BD, Hemphill H, Nyah NN, Kinne V, Ringnwi NI, Yong G, Neufeldt AL, Mitterand Y, Finkelstein FO, Krahn TA. Peritoneal Dialysis for AKI in Cameroon: Commercial vs Locally-Made Solutions. Perit Dial Int 2018; 38:246-250. [PMID: 29793982 DOI: 10.3747/pdi.2017.00190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/11/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in low- and middle-income countries, and is associated with a high mortality. The high mortality rate is in large part due to the inability to perform dialysis in resource-limited settings. Due to significant cost advantages, peritoneal dialysis (PD) has been used to treat AKI in these settings. The costs, however, remain high when commercial solutions are used. METHODS This is a retrospective cohort study of the outcome, and of the peritonitis rates, of patients with AKI treated with either commercially manufactured PD solutions or locally-made PD solutions. A program to treat AKI with PD was started at Mbingo Baptist Hospital in Cameroon. Between May 2013 and January 2015, solutions and connection sets were provided by the Saving Young Lives Program. From January 2015 through March 2017, solutions were locally produced and available tubing was used. RESULTS Mortality in hospitalized AKI patients was 28% during the period when commercial solutions and tubing were utilized, and 33% when locally produced solutions and available tubing were utilized. In both groups, peritonitis occurred in 16% of treatment courses. CONCLUSIONS Locally produced PD solutions, used with locally available tubing, were used to treat AKI with PD. The mortality and peritonitis rates were similar whether locally produced or commercial supplies were used.
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Affiliation(s)
| | - William J Lawton
- Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Charles Barrier
- UNC School of Medicine, Chapel Hill, NC, USA.,Carolinas Medical Center, Charlotte, NC, USA
| | - B D Fine
- Arkansas Renal Group, Hot Springs, AR, USA
| | | | | | | | | | | | | | | | | | - Thomas A Krahn
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ekrikpo UE, Kengne AP, Bello AK, Effa EE, Noubiap JJ, Salako BL, Rayner BL, Remuzzi G, Okpechi IG. Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis. PLoS One 2018; 13:e0195443. [PMID: 29659605 PMCID: PMC5901989 DOI: 10.1371/journal.pone.0195443] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/22/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients. METHODS We searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman-Tukey transformation. RESULT Sixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2-7.7%) with MDRD, 4.8% (95%CI 2.9-7.1%) with CKD-EPI and 12.3% (95%CI 8.4-16.7%) with Cockcroft-Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2-11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9-20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0-3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status. CONCLUSION CKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.
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Affiliation(s)
- Udeme E. Ekrikpo
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Renal Unit, Department of Medicine, University of Uyo, Uyo, Nigeria
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Emmanuel E. Effa
- Renal Unit, Department of Medicine, University of Calabar, Calabar, Nigeria
| | - Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Babatunde L. Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Brian L. Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases Aldo & Cele Daccò, Bergamo, Italy
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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Clinical Profile and Outcome of Patients with Acute Kidney Injury Requiring Hemodialysis: Two Years' Experience at a Tertiary Hospital in Rwanda. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1716420. [PMID: 29780817 PMCID: PMC5892305 DOI: 10.1155/2018/1716420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/30/2018] [Accepted: 02/21/2018] [Indexed: 11/18/2022]
Abstract
Introduction Acute kidney injury (AKI) requiring renal replacement therapy is associated with high mortality. The study assessed the impact of the introduction of hemodialysis (HD) on outcomes of patients with AKI in Rwanda. Methods A single center retrospective study that evaluated the clinical profile and survival outcomes of patients with AKI requiring HD [AKI-D] at a tertiary hospital in Rwanda. Data was collected on patients who received HD for AKI from September 2014 to December 2016. Patient demographics, comorbidities, clinical presentation, laboratory tests, and mortality were reviewed and analyzed. Predictors of mortality were assessed using age and gender adjusted multivariate analyses. Results Of the 82 eligible patients, median age was 38 years (IQR 28–57 years). Males comprised 51% of the cohort. Infectious diseases including malaria, pneumonia, and sepsis (35.1%) and pregnancy-related conditions (26.9%) were the most frequent comorbidities. Pulmonary oedema (54.9%) and uremic encephalopathy (50%) were top indications for HD. Mortality was 34.1%. On multivariate analysis, receipt of <5 sessions of HD (OR = 4.01, 95% CI 1.185–13.61, P = 0.026) and hyperkalemia (OR = 3.23, 95% CI 1.040–10.065, P = 0.043) were associated with mortality. Conclusion The availability of acute hemodialysis in Rwanda has resulted in improved patient survival and persistent hyperkalemia predicted higher mortality.
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Cooke WR, Hemmilä UK, Craik AL, Mandula CJ, Mvula P, Msusa A, Dreyer G, Evans R. Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study. BMC Nephrol 2018; 19:25. [PMID: 29394890 PMCID: PMC5797378 DOI: 10.1186/s12882-018-0824-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric-related acute kidney injury (AKI) is thought to be a key contributor to the overall burden of AKI in low resource settings, causing significant and preventable morbidity and mortality. However, epidemiological data to corroborate these hypotheses is sparse. This prospective observational study aims to determine the incidence, aetiology and maternal-fetal outcomes of obstetric-related AKI in Malawi. METHODS Women greater than 20 weeks gestation or less than 6 weeks postpartum admitted to obstetric wards at a tertiary hospital in Blantyre, Malawi, and at high-risk of AKI were recruited between 21st September and 11th December 2015. All participants had serum creatinine tested at enrolment; those with creatinine above normal range (> 82 μmol/L) underwent serial measurement, investigations to determine cause of kidney injury, and were managed by obstetric and nephrology teams. AKI was diagnosed and staged by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Primary outcomes were the incidence proportion and aetiology of AKI. Secondary outcomes were in-hospital maternal mortality, need for dialysis, renal recovery and length of stay; in-hospital perinatal mortality, gestational age at delivery, birthweight and Apgar score. RESULTS 354 patients were identified at risk of AKI from the approximate 2300 deliveries that occurred during the study period. Three hundred twenty-two were enrolled and 26 (8.1%) had AKI (median age 27 years; HIV 3.9%). The most common primary causes of AKI were preeclampsia/eclampsia (n = 19, 73.1%), antepartum haemorrhage (n = 3, 11.5%), and sepsis (n = 3, 11.5%). There was an association between preeclampsia spectrum and AKI (12.2% AKI incidence in preeclampsia spectrum vs. 4.3% in other patients, p = 0.015). No women with AKI died or required dialysis and complete renal recovery occurred in 22 (84.6%) cases. The perinatal mortality rate across all high-risk admissions was 13.8%. AKI did not impact on maternal or fetal outcomes. CONCLUSIONS The incidence of AKI in high-risk obstetric admissions in Malawi is 8.1% and preeclampsia was the commonest cause. With tertiary nephrology and obstetric care the majority of AKI resolved with no effect on maternal-fetal outcomes. Maternal-fetal outcomes in Sub-Saharan Africa may be improved with earlier detection of hypertensive disease in pregnancy.
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Affiliation(s)
- William R. Cooke
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Obstetrics and Gynaecology, Royal Berkshire Hospital, Craven Road, Reading, RG1 5AN UK
| | - Ulla K. Hemmilä
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Alison L. Craik
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chimwemwe J. Mandula
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Priscilla Mvula
- Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ausbert Msusa
- Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Gavin Dreyer
- Department of Nephrology, Bart’s Health NHS Trust, London, UK
| | - Rhys Evans
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
- University College London Centre for Nephrology, Royal Free Hospital, Pond Street, London, NW3 2QG UK
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39
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Chikwapulo B, Ngwira B, Sagno JB, Evans R. Renal outcomes in patients initiated on tenofovir disoproxil fumarate-based antiretroviral therapy at a community health centre in Malawi. Int J STD AIDS 2018; 29:650-657. [PMID: 29334883 DOI: 10.1177/0956462417749733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tenofovir-based antiretroviral therapy (TDF ART) is the first-line regimen for human immunodeficiency virus (HIV) in Africa. However, contemporary data on nephrotoxicity are lacking. We determined the renal outcomes of patients commenced on TDF ART in Malawi. ART-naïve patients initiated on TDF ART at a community health centre between 1 July 2013 and 31 December 2015 were included. The estimated glomerular filtration rate (eGFR, Cockcroft-Gault) was recorded at the initiation of therapy and over 18 months thereafter. The prevalence of renal impairment at ART initiation (eGFR < 60 ml/min) and the incidence of nephrotoxicity (eGFR < 50 ml/min) were determined. A total of 439 patients (median age: 32 years; 317 [72.2%] female) were included. Twenty-one (4.8%) patients had renal impairment at ART initiation; eGFR improved in all during follow-up. Nephrotoxicity occurred in 17 (4.0%) patients with eGFR > 50 ml/min at baseline, predominantly within the first six months of therapy. Increasing age and diastolic hypertension (>100 mmHg) were independent risk factors for nephrotoxicity development. The prevalence of kidney disease at ART initiation was 4.8% and nephrotoxicity occurred in 4.0%. Some eGFR decline may have been due to weight gain. Targeted monitoring of kidney function six months after TDF initiation should be considered in Malawi.
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Affiliation(s)
- Bongani Chikwapulo
- 1 Department of Public Health, College of Medicine, University of Malawi College of Medicine, University of Malawi, Blantyre, Malawi
| | - Bagrey Ngwira
- 2 Department of Environmental Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Rhys Evans
- 4 Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,5 Centre for Nephrology, University College London Centre for Nephrology, University College London, London, UK
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Raji YR, Ajayi SO, Ademola AF, Lawal TA, Ayandipo OO, Adigun T, Salako B. Acute kidney injury among adult patients undergoing major surgery in a tertiary hospital in Nigeria. Clin Kidney J 2018; 11:443-449. [PMID: 30094006 PMCID: PMC6070100 DOI: 10.1093/ckj/sfx144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/20/2017] [Indexed: 12/17/2022] Open
Abstract
Background Acute kidney injury (AKI) is an underreported but major cause of morbidity and mortality among patients undergoing major surgical interventions in sub-Saharan Africa (SSA). Whereas AKI is often seen following major cardiac surgery in high-income countries, a similar spectrum of surgical diseases and interventions is not seen in developing countries. The impacts on surgical outcomes have also not been well characterized in SSA. This study aimed at identifying risk factors, incidence and determinants and short-term outcomes of AKI among patients undergoing major surgery. Methods This was a cohort study of adult patients undergoing major surgery at the University College Hospital, Ibadan, Nigeria. Data obtained were sociodemographic details, risk factors for AKI, details of surgery, anaesthesia and intra-operative events and short-term outcomes. Blood samples were obtained for pre-operative (pre-op) full blood count, serum electrolytes, blood urea and creatinine (SCr). Post-operatively (Post-op) SCr was determined at 24 h, Day 7 post-op and weekly until each patient was discharged. Results A total of 219 subjects who had major surgery (86.3% elective) were enrolled. The median age of the patients was 46 (range 18-73) years and 72.6% were females. The surgeries performed were mostly simple mastectomies (37.4%), exploratory laparotomies (22.8%) and total thyroidectomies (16.4%). The incidences of AKI were 18.7% at 24 h and 17.4% at Day 7 post-op, while cumulative AKI incidence was 22.5% at 1-week post-op. Pre-op elevated SCr [odds ratio (OR) 3.86], sepsis (OR 2.69), anaemia (OR 2.91) and duration of surgery >120 min (OR 1.75) were independently associated with AKI. In-patient mortality was 20.4% in individuals with AKI and 5.3% in those without AKI (P < 0.01). Conclusion Peri-operative risk factors for AKI are common among patients undergoing major surgery in SSA hospitals. The cumulative incidence of AKI was high and independently associated with pre-op sepsis, anaemia, pre-existing kidney dysfunction and duration of surgery >120 min.
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Affiliation(s)
- Yemi Raheem Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Samuel Oluwole Ajayi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeyinka F Ademola
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Taiwo Akeem Lawal
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Omobolaji O Ayandipo
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tinuola Adigun
- Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babatunde Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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41
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Evans RDR, Cooke W, Hemmila U, Calice-Silva V, Raimann J, Craik A, Mandula C, Mvula P, Msusa A, Dreyer G, Levin NW, Pecoits-Filho R. A Salivary Urea Nitrogen Dipstick to Detect Obstetric-Related Acute Kidney Disease in Malawi. Kidney Int Rep 2017; 3:178-184. [PMID: 29340329 PMCID: PMC5762969 DOI: 10.1016/j.ekir.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/24/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023] Open
Abstract
Introduction Obstetric-related acute kidney injury (AKI) is associated with adverse outcomes for mother and fetus, particularly in low-income countries. However, laboratory-independent tools to facilitate diagnosis are lacking. We assessed the diagnostic performance of a salivary urea nitrogen (SUN) dipstick to detect obstetric-related acute kidney disease in Malawi. Methods Women at high risk for AKI admitted to an obstetric unit in Blantyre, Malawi, were recruited between 21 September and 11 December 2015. Patients underwent serum creatinine (SCr) testing alongside measurement of SUN using a dipstick on admission, and every 48 hours thereafter if evidence of kidney disease was found. Results A total of 301 patients were included (mean age 25.9 years, 11% HIV positive). Of the patients, 23 (7.6%) had AKI, stage 1 in 47.8%, most commonly due to preeclampsia/eclampsia. Mean presenting SCr values were 108.8 ± 21.8 μmol/l (1.23 ± 0.25 mg/dl), 118 ± 34.45 μmol/l (1.33 ± 0.39 mg/dl), and 136.1 ± 30.4 μmol/l (1.54 ± 0.34 mg/dl) in AKI stages 1 to 3 respectively. SUN > 14 mg/dl had a sensitivity of 12.82% and a specificity of 97.33% to detect acute kidney disease; the area under the receiver operating characteristic curve was 0.551. In patients with normal SUN on admission, perinatal mortality was 11.8%, and was 25.0% if SUN was > 14 mg/dl (P = 0.18). Conclusion The SUN dipstick was specific but insensitive when used to diagnose obstetric-related AKI. Limited biochemical derangement and low salivary urea concentrations due to physiological changes in pregnancy, as opposed to a technical limitation of the dipstick itself, are the likely reason for the lack of sensitivity in this study.
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Affiliation(s)
- Rhys D R Evans
- University of Malawi College of Medicine, Malawi.,University College London Centre for Nephrology, London, UK.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - William Cooke
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ulla Hemmila
- University of Malawi College of Medicine, Malawi.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Viviane Calice-Silva
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Pró-rim Foundation, Joinville, Brazil
| | | | - Alison Craik
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chimwemwe Mandula
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Priscilla Mvula
- Obstetric Department, Queen Elizabeth Central Hospital, Malawi
| | - Ausbert Msusa
- University of Malawi College of Medicine, Malawi.,Obstetric Department, Queen Elizabeth Central Hospital, Malawi
| | - Gavin Dreyer
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Bart's Health, London, UK
| | - Nathan W Levin
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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