Hospital-Acquired Acute Kidney Injury in Non-Critical Medical Patients in a Developing Country Tertiary Hospital: Incidence and Predictors

Abstract

Nahom Dessalegn Mekonnen,1 Tigist Workneh Leulseged,1,2 Buure Ayderuss Hassen,3 Kidus Haile Yemaneberhan,4 Helen Surafeal Berhe,5 Nebiat Adane Mera,6 Anteneh Abera Beyene,4 Lidiya Zenebe Getachew,7 Birukti Gebreyohannes Habtezgi,3 Feven Negasi Abriha8 1Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Clinical Research Capacity Building Unit, Medical Research Lounge (MRL), Addis Ababa, Ethiopia; 3Department of Internal Medicine, Hayat Medical College, Addis Ababa, Ethiopia; 4Department of Internal Medicine, Myungsung Medical College Comprehensive Specialized Hospital, Addis Ababa, Ethiopia; 5Department of Internal Medicine, Afya Clinic, Kansas City, Missouri, USA; 6Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 7Department of Internal Medicine, Eka Kotebe General Hospital, Addis Ababa, Ethiopia; 8Department of Internal Medicine, Jimma University School of Medicine, Jimma, EthiopiaCorrespondence: Tigist Workneh Leulseged, Email [email protected]: Acute kidney injury (AKI) is a frequent complication in critical patients, leading to a worse prognosis. Although its consequences are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Therefore, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia.Methods: A retrospective chart review study was conducted from September 25, 2022 to January 20, 2023 among 232 hospitalized non-critical medical patients admitted to St. Paul’s Hospital Millennium Medical College between January 2020 and January 2022. The incidence of HAAKI was estimated using incidence density per total person day (PD) observation of the study participants. To identify predictors of HAAKI, a log binomial regression model was fitted at a p value of ≤ 0.05. The magnitude of association was measured using adjusted relative risk (ARR) with its 95% CI.Results: During the median follow-up duration of 11 days (IQR, 6– 19 days), the incidence of HAAKI was estimated to be 6.0 per 100 PD (95% CI = 5.5 to 7.2). Significant predictors of HAAKI were found to be having type 2 diabetes mellitus (ARR = 2.36, 95% CI = 1.03, 5.39, p-value=0.042), and taking vancomycin (ARR = 3.04, 95% CI = 1.38, 6.72, p-value=0.006) and proton pump inhibitors (ARR = 3.80, 95% CI = 1.34,10.82, p-value=0.012).Conclusion: HAAKI is a common complication in hospitalized non-critical medical patients, and is associated with a common medical condition and commonly prescribed medications. Therefore, it is important to remain vigilant in the prevention and timely identification of these cases and to establish a system of rational prescribing habits.Keywords: hospital-acquired acute kidney injury, non-critical setting, retrospective chart review, log binomial regression, Ethiopia

Keywords

• hospital acquired acute kidney injury
• non-critical setting
• retrospective chart review
• log binomial regression
• ethiopia