Acute kidney injury among adult patients admitted with critical illness in tertiary hospitals in Dodoma

Introduction: The incidence of acute kidney injury (AKI) is highest in low and middle income countries despite the International Society of Nephrology (ISN) 0 by 2025 initiative. Critically ill patients are at increased risk for developing AKI, chronic kidney disease (CKD), end stage renal disease and death. Methodology : A prospective observational study was conducted among critically ill patients attending tertiary hospitals in Dodoma between October 2023 and May 2024. At baseline, patients’ demographic and clinical data were collected and laboratory investigations were performed to evaluate AKI. Patients were evaluated for AKI using the KDIGO criteria at baseline, 48 hours, on the 7th day and eGFR was calculated after 3 months using CKD-EPI equation. Atatistical analyses were conducted with SPSS (version 27). Logistic regression analyses were used to identify factors associated with AKI among critically ill patients and cox proportional hazard was used to determine predictors of mortality. Results: A total of 303 critically ill patients were enrolled into the study with a median age of 45 (IQR 32–65) years and 54.8% were male. On admission; the median serum creatinine was 101(89–155)µmol/L and the median haemoglobin was 13(9–14) g/dl. The incidence of AKI among critically ill patients was 49.5% (150/303). Factors associated with AKI included; HFheart failure [OR 5.3, 95% CI (1.34–21.1), P  =  0.018], use of local herbs [OR 4.7, 95% CI (1.53–14.33), P = 0.007], malignancy [OR 4.5, 95% CI (1.53-13.0), P = 0.006], obstetric complications [OR 3.69, 95% CI (1.25–10.88), P  = 0.018 ], illness severity [OR 2.57, 95% (CI 1.30–5.06), P  = 0.006 ] and sepsis [OR 2.56, 95% (CI 1.18–5.55) P  = 0.018 ]. Patients with AKI had longer mean hospital stays as compared to those without AKI(p < 0.01), 10% (15/150) developed CKD and 46.7% (70/150) died. Predictors of mortality were age [HR 2.1, 95% CI (1.25–3.5), p = 0.005 ] and AKI [HR 1.82, 95% (CI 1.16–2.87), p = 0.01 ]. Conclusion: The incidence of AKI and its associated mortality is high among adult patients admitted with critical illness in our settings. Use of local herbs, heart failure, severity of illness,malignancy, obstetric complications and sepsis were found to be strongly associated with AKI. Patients with AKI had longer mean hospital stays and almost half of the patients AKI died during hospitalization.