Masewu A1, Makulo JR2, Lepira F3, Amisi EB1, Sumaili EK3, Bukabau J3,4, Mokoli V3, Longo A3, Nlandu Y3, Engole Y3, Ilunga C3,Mosolo A1,5, Ngalala A6,4, Kazadi J7, Mvuala R8, Athombo J9, Aliocha N3, Akilimali PZ10, Kilembe A1,8, Nseka N3, Jadoul M11.

  • 1Intensive Care Unit, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
  • 2Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo. jrmakulo2016@gmail.com.
  • 3Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
  • 4Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo.
  • 5Intensive Care Unit, Centre Hospitalier de Monkole, Kinshasa, Democratic Republic of Congo.
  • 6Intensive Care Unit, Hôpital Sino-Congolais de Kinshasa, Kinshasa, Democratic Republic of Congo.
  • 7Intensive Care Unit, Hôpital Général Provincial de Référence de Kinshasa, Kinshasa, Democratic Republic of Congo.
  • 8Intensive care unit, Clinique Ngaliema, Kinshasa, Democratic Republic of Congo.
  • 9Intensive care unit, Hôpital Biamba Marie Mutombo, Kinshasa, Democratic Republic of Congo.
  • 10Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
  • 11Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

Abstract

BACKGROUND:

Despite the growing incidence of acute kidney injury (AKI) worldwide, there is little data on the burden and outcomes of AKI in intensive care unit (ICU) in low resource settings. The present study assessed the incidence of AKI and its impact on mortality in ICU in Kinshasa (Democratic Republic of Congo).

METHODS:

In a prospective cohort study, 476 consecutive critically ill patients (mean age 52 years, 57 % male) were screened for the presence of AKI in seven ICU from January 1st to March 30th, 2015. Serum creatinine was measured by the enzymatic method (Cobas C111 device®). AKI and its stages (no AKI, AKI 1, AKI 2 and AKI 3) were defined according to AKIN recommendations. The primary outcome was 28 days mortality. Survival (time-to death) curves were built using the Kaplan Meier methods. Predictors of mortality were assessed by Cox proportional hazards regression models. p < 0.05 defined the level of statistical significance.

RESULTS:

The cumulative incidence of AKI was 52.7 % with AKI stage 1, 2 and 3 in 23.7 %, 16.2 % and 12.8 % of patients, respectively. Among patients who developed AKI, 146 died (58 %) vs 62 patients (28 %) in the group without AKI. Only 6.5 % of the patients with AKI stage 3 benefited from dialysis. Median survival time was 15.0 days in patients without AKI and 3.0 days, 6.0 days and 8.0 days in patients with AKI stage 3, 2 and 1 (p < 0.001), respectively. In addition to respiratory distress-induced polypnea (HRa 1.60; 95 % CI: 1.08-2.37; p = 0.018), oxygen desaturation (HRa 1.53; 95 % CI: 1.13-2.08; p = 0.006) and multi-organic involvement (HRa 1.63; 95 % CI: 1.15-2.30), AKI emerged as an independent predictor of death (HRa 1.82; 95 % CI: 1.34-2.48; p < 0.001).

CONCLUSION:

More than half of critically ill patients in the present cohort developed AKI which contributed substantially to short-term mortality, highlighting the need for its prevention, early detection and management as well as the availability of dialysis in ICU.

KEYWORDS:

Acute kidney injury; Black Africans; Incidence; Intensive care unit; Mortality