Risk, Predictors, and Outcomes of Acute Kidney Injury in Patients Admitted to Intensive Care Units in Egypt

Abstract

Epidemiology of acute kidney injury (AKI) in developing countries is under-studied. We evaluated the risk and prognosis of AKI in patients admitted to intensive care units (ICUs) in Egypt. We recruited consecutive adults admitted to ICUs in Alexandria Teaching Hospitals over six months. We used the KDIGO criteria for AKI. We followed participants until the earliest of ICU discharge, death, day 30 from entry or study end. Of the 532 participants (median age 45 (Interquartile range [IQR]: 30-62) years, 41.7% male, 23.7% diabetics), 39.6% had AKI at ICU admission and 37.4% developed AKI after 24 hours of ICU admission. Previous need of diuretics, sepsis and low education were associated with AKI at ICU admission; APACHE II score independently predicted AKI after ICU admission. A total of 120 (22.6%) patients died during 30-day follow-up. Compared to patients who remained AKI-free, mortality was significantly higher in patients who had AKI at study entry (Hazard Ratio [HR] 2.14; 95% Confidence Interval [CI] 1.02-4.48) or developed AKI in ICU (HR 2.74; 95% CI 1.45-5.17). The risk of AKI is high in critically ill people and predicts poor outcomes. Further studies are needed to estimate the burden of AKI among patients before ICU admission.

Figure 1

Flow chart of the study cohort.

Figure 2

Etiology of AKI by timing of diagnosis: at ICU and after ICU admission.

Figure 3

Predictors of 30-day mortality among ICU patients.

Figure 4

Different outcomes among the study cohort. AKI at ICU admission indicates people diagnosed with acute kidney injury (AKI) when they were admitted to intensive care unit (ICU); AKI after ICU admission indicates people who were AKI free when they were admitted but developed AKI during the study; AKI-free indicates people who remained AKI-free during the study. Hospital stay refers to the need to remain in the hospital beyond 30 days from ICU entry or transfer to another non-ICU unit. Death refers to 30 days mortality. Renal recovery is considered when the last available creatinine on ICU admission fell within 0.3 mg/dl or 50% of the baseline value, without requirements for renal replacement therapy.