INCIDENCE AND PREDICTORS OF ACUTE KIDNEY INJURY AMONG CRITICALLY ILL ADULT PATIENTS ADMITTED AT MBARARA REGIONAL REFERRAL HOSPITAL

 

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https://storage.unitedwebnetwork.com/files/1099/414b1f3e381a64e2cc6e6dffaa3f6626.pdf
INCIDENCE AND PREDICTORS OF ACUTE KIDNEY INJURY AMONG CRITICALLY ILL ADULT PATIENTS ADMITTED AT MBARARA REGIONAL REFERRAL HOSPITAL

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Rose
Muhindo
Rose Muhindo rosie@must.ac.ug Mbarara University of Science and Technology Department of Internal Medicine Mbarara Uganda *
Joshua Kiptoo jkiptoo@must.ac.ug Mbarara University of Science and Technology Department of Pharmacy Mbarara Uganda -
Christine Tumuhimbise christel8008@gmail.com Mbarara Regional Referral Hospital Department of Anaesthesia and Critical Care Mbarara Uganda -
Caroline Nakyanzi nakyanzicaroline@gmail.com Mbarara Regional Referral Hospital Department of Anaesthesia and Critical Care Mbarara Uganda -
Francis Ssentongo gonzagassentongo84@gmail.com Mbarara University of Science and Technology Department of Internal Medicine Mbarara Uganda -
Michael Kavubu kavubumichael@gmail.com Mbarara University of Science and Technology Department of Internal Medicine Mbarara Uganda -
Ernest Ssewanyana ssewanyanaernest@gmail.com Mbarara University of Science and Technology Department of Internal Medicine Mbarara Uganda -
John Isiiko jisiiko@must.ac.ug Mbarara University of Science and Technology Department of Pharmacy Mbarara Uganda -
Julius Kyomya kyomyaj@gmail.com Mbarara University of Science and Technology Department of Pharmacy Mbarara Uganda -
Andrew Mutekanga mutekangaandrew7@gmail.com Mbarara University of Science and Technology Department of Internal Medicine Mbarara Uganda -
Rachel Alum Aguma rachyblsd@gmail.com Mbarara University of Science and Technology Department of Anaesthesia and Critical Care Mbarara Uganda -
Judith Owokuhaisa Judith Owokuhaisa Mbarara University of Science and Technology Department of Nursing Mbarara Uganda -
Tadele Mekuriya Yadesa maatiikoo4@gmail.com Kampala International University Department of Clinical Pharmacy and Pharmacy Practice Ishaka Uganda -
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Background:  Severely ill patients are vulnerable to developing Acute Kidney Injury (AKI), with variable incidence, but limited data from LMICs. We evaluated the incidence, predictors, treatment, and outcomes of AKI among very ill adult patients at a public tertiary hospital in Southwestern Uganda.

Methods: This prospective cohort study categorized patients who had a NEWS-2 above 5 as critically ill. We used the “Kidney Disease Improving Global Outcomes (KDIGO)” definition of AKI as a 0.3 mg/dl increase in serum creatinine within 48 hours. Participants were followed up until day 7 of admission, death or discharge, whichever occurred first. STATA version 13 was used for data analysis. Predictors of AKI were determined by logistic regression.

Results: Of 161 critically ill patients, the median age was 48 years (IQR: 31-65). The incidence of AKI was 70 (95% CI 55 – 90) per 1000 person days of observation. 39.1% (127) drugs used during hospitalization were deemed potentially nephrotoxic, and 60% (96) of participants were exposed to at least one nephrotoxic drug. Penicillins and loop diuretics were the most commonly used nephrotoxic drugs.  Predictors of AKI included: previous hospitalization in the last 3 months (aOR 2.56, 95% CI: 1.08-6.06, P=0.032), admission to the surgical ward (aOR 4.32, 95% CI: 1.22-15.24, P=0.023), elevated baseline creatinine (>1.2 mg/dl) (aOR 2.44, 95% CI: 1.13-5.27, P=0.023) and elevated baseline WBC count (>12 x 109/µl) (aOR 2.57, 95% CI: 1.21-5.46, P=0.014). Most AKI patients were managed conservatively; 25% of patients with stage 3 received hemodialysis, and 25% of those with incident AKI died in the hospital.

Conclusion: We found a high prevalence of AKI among critically ill patients (70 per 1000 person days). Previous hospitalization in the past 3 months, high baseline creatinine, high baseline WBC count and admission to the surgical ward were independently associated with AKI.

Kewords