Pattern and prognostic factors of acute kidney injury in an intensive care unit in Nigeria

Abstract

Introduction; Acute kidney injury (AKI) is a clinical entity with significantly high morbidity and mortality rates especially in the intensive care setting. Few previous studies in this area have employed less sensitive criteria with limited results. Thus, application of newer criteria and prognostic scores will give a true picture of the magnitude of the problem in this particular setting. Methodology; This study was carried out among 100 consecutive patients admitted to the intensive care unit (1CU) over an eighteen-month period to determine the occurrence, frequency, and outcomes, and to also seek a relationship between the diagnostic criteria of AKI such as the Risk, Injury, Failure, Loss and End stage (RIFLE) and the Acute Kidney Injury Network (AKIN) criteria respectively and the Acute Physiological and Chronic Health Evaluation, (APACHE) IV. The outcome measures in these patients were as follows; need for hemodialysis, survival without hemodialysis or death. Results; The patients studied were aged between 18 and 70 years (Mean± SD; 41.5± 16.3) and the male to female ratio of 1.4:1. The incidence of AKI in patients admitted into the ICU was 54 (54%). Using the RIFLE criteria, 37% were in the Injury stage while 46.3% were in stage 2 using the AKIN criteria. Surgical cases such as head injuries and advanced carcinomas constituted the major primary aetiology (72.2%). The presence of other organ system failure (apart from the kidney) was largely predictive of outcome among ICU patients (p<0.001). 47 patients had other organ systems failure. Out of these, only 7 (14.9%) of them survived. There was a higher APACHE IV scores (6.1.1± 24.3) in patients that developed AKI compared to those that did not develop AKI (55.2 ± 19.9).