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Haemodialysis is the most common form of renal replacement therapy available in Zimbabwe. There is limited data on the number, nature and outcomes of patients who require dialysis as treatment for severe acute kidney injury (AKI) in sub-Saharan Africa. The Dialysis in Zimbabwe (DIAZ) project was designed to collect and report on incidence, distribution, characteristics and outcomes of patients with kidney failure across both public and private institutions in Zimbabwe. This analysis focuses upon the sub-group of patients requiring dialysis for AKI, to describe the demographic and clinical characteristics of these incident patients and to define survival outcomes and the factors influencing survival.
This observational cohort study included all adult incident patients who commenced dialysis for AKI in Zimbabwe corresponding to stage 3 AKI in the KDIGO AKI guidelines, between 1 February 2018 and 28 February 2019. Data was collected from 16 dialysis units nationwide at commencement of dialysis then at 1,3,6 and 12 months post commencement. Observation time was censored at the latest time point of death, loss to follow-up or end of the study, and recovery of renal function was defined as cessation of the requirement for dialysis. The cumulative incidence of recovery and death without recovery was analysed using a competing risks approach.
A total of 614 incident patients commenced dialysis in the 1-year enrolment period of the DIAZ Study, with 344 (56%) consenting to participate in the study, of whom 158 were classified as having AKI. All the patients with AKI were managed using intermittent haemodialysis. They were predominantly female (56%) and young (mean age 38yrs) and 23% of the patients were HIV positive. Most patients (84%) were managed in a public hospital dialysis unit. The commonest cause for AKI was infection (39%, including sepsis, malaria and human immunodeficiency virus-related infection) followed by preeclampsia/eclampsia (23%).
Figure 1 shows the cumulative incidence probability for renal recovery. Most renal recovery occurred within approximately 100 days after commencement of dialysis. There was significant mortality in the AKI cohort which was also mostly within 100 days of dialysis initiation. A diagnosis of diabetes mellitus, the number of dialysis hours and dialysis within a public unit were associated with increased risk of mortality. 21% of patients required dialysis beyond 90 days and at 1 year 11% of patients were still on dialysis.
Infection and preeclampsia/eclampsia are leading causes of AKI requiring dialysis in Zimbabwe similar to other low to middle income countries. There is significant early mortality in patients with AKI requiring dialysis.