Acute kidney injury among adult patients with sepsis in a low-income country: clinical patterns and short-term outcomes
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Nephrology
Abstract
Acute kidney injury (AKI) is a common complication of sepsis. We determined the prevalence of AKI
among adult patients with sepsis on the medical wards in a low-income country and described their clinical pattern
and outcomes at discharge.
Methods: We conducted a cross-sectional study of sepsis-related AKI on the adult medical wards of Mulago
National Referral Hospital between January and April 2013. All patients meeting the American College of
Chest Physicians (ACP) sepsis criteria were recruited. Demographic, clinical, laboratory and ultrasonography
data were recorded and all patients with AKI were followed up to a maximum of 2 weeks. Proportional analysis
was carried out and odds ratios with 95% confidence intervals were calculated in the bivariate analysis.
Results: Of 387 patients recruited, 217 (55.6%) were male and the average age was 37 years (range18–90 years). The
prevalence of sepsis-related AKI was 16.3%. Age >59 years (p = 0.023), a postural drop in systolic blood pressure
of >9 mmHg (p = 0.015) and a white blood cell count >12,000 cells/mL (p = 0.003) were significantly associated with
AKI. In-hospital mortality among patients with AKI was 21% (13/63). 59% (20/49) of patients who were discharged alive
or were still on the wards after 2 weeks had persistent kidney injury. Acute Kidney Injury Network (AKIN) Stage 3
was significantly associated with persistence of kidney injury (p = 0.001). None of the patients requiring dialysis
or ICU care received either because of limited access.
Conclusions: The prevalence, morbidity and mortality due to AKI among sepsis patients in Uganda is very
high and limited access to dialysis and ICU care is a major factor in poor outcomes for these patients.
Description
Keywords
Acute kidney injury, AKIN, Sepsis, Mortality, Resource-limited setting, Africa
Citation
Bagasha et al.: Acute kidney injury among adult patients with sepsis in a low-income country: clinical patterns and short-term outcomes. BMC Nephrology 2015 16:4. doi:10.1186/1471-2369-16-4