Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study
| dc.contributor.author | Aylward, Ryan E | |
| dc.contributor.author | van der Merwe, Elizabeth | |
| dc.contributor.author | Pazi, Sisa | |
| dc.contributor.author | van Niekerk, Minette | |
| dc.contributor.author | Ensor, Jason | |
| dc.contributor.author | Baker, Debbie | |
| dc.contributor.author | Freercks, Robert J | |
| dc.date.accessioned | 2019-12-18T08:47:24Z | |
| dc.date.available | 2019-12-18T08:47:24Z | |
| dc.date.issued | 2019-12-10 | |
| dc.date.updated | 2019-12-15T08:41:20Z | |
| dc.description.abstract | Abstract Background There is a marked paucity of data concerning AKI in Sub-Saharan Africa, where there is a substantial burden of trauma and HIV. Methods Prospective data was collected on all patients admitted to a multi-disciplinary ICU in South Africa during 2017. Development of AKI (before or during ICU admission) was recorded and renal recovery 90 days after ICU discharge was determined. Results Of 849 admissions, the mean age was 42.5 years and mean SAPS 3 score was 48.1. Comorbidities included hypertension (30.5%), HIV (32.6%), diabetes (13.3%), CKD (7.8%) and active tuberculosis (6.2%). The most common reason for admission was trauma (26%). AKI developed in 497 (58.5%). Male gender, illness severity, length of stay, vasopressor drugs and sepsis were independently associated with AKI. AKI was associated with a higher in-hospital mortality rate of 31.8% vs 7.23% in those without AKI. Age, active tuberculosis, higher SAPS 3 score, mechanical ventilation, vasopressor support and sepsis were associated with an increased adjusted odds ratio for death. HIV was not independently associated with AKI or hospital mortality. CKD developed in 14 of 110 (12.7%) patients with stage 3 AKI; none were dialysis-dependent. Conclusions In this large prospective multidisciplinary ICU cohort of younger patients, AKI was common, often associated with trauma in addition to traditional risk factors and was associated with good functional renal recovery at 90 days in most survivors. Although the HIV prevalence was high and associated with higher mortality, this was related to the severity of illness and not to HIV status per se. | |
| dc.identifier.apacitation | Aylward, R. E., van der Merwe, E., Pazi, S., van Niekerk, M., Ensor, J., Baker, D., & Freercks, R. J. (2019). Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study. http://hdl.handle.net/11427/30710 | en_ZA |
| dc.identifier.chicagocitation | Aylward, Ryan E, Elizabeth van der Merwe, Sisa Pazi, Minette van Niekerk, Jason Ensor, Debbie Baker, and Robert J Freercks "Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study." (2019) http://hdl.handle.net/11427/30710 | en_ZA |
| dc.identifier.citation | BMC Nephrology. 2019 Dec 10;20(1):460 | |
| dc.identifier.ris | TY - Journal Article AU - Aylward, Ryan E AU - van der Merwe, Elizabeth AU - Pazi, Sisa AU - van Niekerk, Minette AU - Ensor, Jason AU - Baker, Debbie AU - Freercks, Robert J AB - Abstract Background There is a marked paucity of data concerning AKI in Sub-Saharan Africa, where there is a substantial burden of trauma and HIV. Methods Prospective data was collected on all patients admitted to a multi-disciplinary ICU in South Africa during 2017. Development of AKI (before or during ICU admission) was recorded and renal recovery 90 days after ICU discharge was determined. Results Of 849 admissions, the mean age was 42.5 years and mean SAPS 3 score was 48.1. Comorbidities included hypertension (30.5%), HIV (32.6%), diabetes (13.3%), CKD (7.8%) and active tuberculosis (6.2%). The most common reason for admission was trauma (26%). AKI developed in 497 (58.5%). Male gender, illness severity, length of stay, vasopressor drugs and sepsis were independently associated with AKI. AKI was associated with a higher in-hospital mortality rate of 31.8% vs 7.23% in those without AKI. Age, active tuberculosis, higher SAPS 3 score, mechanical ventilation, vasopressor support and sepsis were associated with an increased adjusted odds ratio for death. HIV was not independently associated with AKI or hospital mortality. CKD developed in 14 of 110 (12.7%) patients with stage 3 AKI; none were dialysis-dependent. Conclusions In this large prospective multidisciplinary ICU cohort of younger patients, AKI was common, often associated with trauma in addition to traditional risk factors and was associated with good functional renal recovery at 90 days in most survivors. Although the HIV prevalence was high and associated with higher mortality, this was related to the severity of illness and not to HIV status per se. DA - 2019-12-10 DB - OpenUCT DP - University of Cape Town KW - AKI KW - Africa KW - HIV KW - ICU KW - Dialysis LK - https://open.uct.ac.za PY - 2019 T1 - Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study TI - Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study UR - http://hdl.handle.net/11427/30710 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12882-019-1620-7 | |
| dc.identifier.uri | http://hdl.handle.net/11427/30710 | |
| dc.identifier.vancouvercitation | Aylward RE, van der Merwe E, Pazi S, van Niekerk M, Ensor J, Baker D, et al. Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study. 2019; http://hdl.handle.net/11427/30710. | en_ZA |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s). | |
| dc.subject | AKI | |
| dc.subject | Africa | |
| dc.subject | HIV | |
| dc.subject | ICU | |
| dc.subject | Dialysis | |
| dc.title | Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study | |
| dc.type | Journal Article |