Incidence, Risk Factors, and Short-Term Outcomes of Acute Kidney Injury in Patients Admitted to Intensive Care Units in Selected Hospitals in Southern Ethiopia: A Prospective Cohort Study

Background Acute kidney injury (AKI) frequently occurs in critically ill patients and contributes significantly to poor clinical outcomes. However, information from low-resource settings is still limited. Objective To determine the incidence, predictors, and short-term outcomes of acute kidney injury (AKI) among adult intensive care unit (ICU) patients in southern Ethiopia. Methods A prospective cohort study was conducted among 384 adult patients admitted to the ICUs of Hawassa Comprehensive Specialized Hospital and Dilla University General Hospital from November 2022 to November 2024. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria on the basis of changes in serum creatinine values. Serum creatinine was measured on the day of intensive care unit (ICU) admission and after 24 hours and then monitored daily or continuously for critically ill patients who were at risk for, or had already developed, acute kidney injury (AKI).Independent predictors were identified via multivariable logistic regression, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported. Results The overall incidence of AKI was 33.6% (95% CI: 28.9–38.6%), with stage 3 AKI accounting for 35.7% of cases. Independent predictors of AKI included older age (AOR = 1.02, 95% CI: 1.01–1.04), the presence of any comorbidity (AOR = 8.78, 95% CI: 3.07–21.07), diabetes mellitus (AOR = 10.96, 95% CI: 3.47–14.63), sepsis (AOR = 1.28, 95% CI: 1.20–2.37), hypovolemia (AOR = 4.12, 95% CI: 2.14–7.37), prolonged ICU stay > 7 days (AOR = 1.47, 95% CI: 1.10–1.95), and admission to medical (AOR = 1.17, 95% CI: 0.85–1.62) or surgical ICUs (AOR = 1.18, 95% CI: 0.86–1.63). Deaths in the ICU were considerably greater among those who developed AKI than among those who did not (57.8% versus 42.2%, p < 0.001). Conclusion AKI affects one-third of ICU patients in southern Ethiopia and is associated with older age, comorbidities, diabetes, sepsis, hypovolemia, and prolonged ICU stay. Early recognition and targeted management of high-risk patients are essential to reduce AKI-related morbidity and mortality, especially in resource-limited settings.