Epidemiology, Management and Risk Factors Associated with Mortality in Acute Kidney Failure in Head Hospital in a Low-Income Country in Africa

Abstract

Objective: To describe the epidemiological, therapeutic, and mortality factors of acute kidney injury (AKI) in the multi-specialty intensive care unit (ICU) of the Brazzaville University Hospital (BHC). Patients and Methods: The study was cross-sectional, conducted from January 1 to June 30, 2023, in the multi-specialty ICU of the BHC. We included all patients aged 18 years and older with AKI. Epidemiological, clinical, and therapeutic variables were analyzed using Epi-info version 7.2 and IBM-SPSS 20. Results: Of 220 adult admissions, 91 patients had AKI (40.6%). The mean age was 46.8 ± 19.4 years with sex ratio of 0.9. The presence of comorbidity was observed in 57.1% and dominated by arterial hypertension and diabetes mellitus. Admissions were surgical (50.6%), including 39.6% from the operating room. The reasons for admission were dominated by arterial hypotension (48.4%), respiratory distress (34.0%) and impaired consciousness (30.8%). The main diagnoses were dominated by acute generalized peritonitis (25.3%) and severe preeclampsia (8.8%). AKI was parenchymal (70.3%) and classified as KDIGO stage 3 (49.4%). Anuria (82.1%) and hyperkalemia (37.5%) were the observed consequences. Management consisted of ultrasound-guided fluid replacement (33.0%), catecholamine therapy (58.2%), mechanical intubation-ventilation (61.5%), and dialysis (17.6%). The mortality rate was 50.5% by multi-organ failure. The mortality associated factors were: Glasgow Coma Scale score ≤ 8, oligoanuria, liver failure, KDIGO stages 2 and 3, and mechanical ventilation. Conclusion: AKI is common and carries a high mortality rate in ICU. The most common diagnoses were generalized peritonitis and eclampsia. Management is difficult due to the lack of a dialysis unit at the BHC.