Risk factors and outcomes of sepsis-associated acute kidney injury in intensive care units in Johannesburg, South Africa
DOI:
https://doi.org/10.7196/SAMJ.2022.v112i12.16410Keywords:
Acute kidney, SepsisAbstract
Background. Sepsis-associated acute kidney injury (SA-AKI) has been shown to be a significant contributor to morbidity and mortality in both children and adults with critical illness. In sub-Saharan Africa, there is a lack of information on factors associated with development of SA-AKI and outcomes after intensive care unit (ICU) admission.
Objectives. To assess the rate of SA-AKI, factors associated with its development, and predictors of mortality at 90 days in critically ill
patients admitted to the ICU with sepsis.
Methods. This was a prospective observational study conducted at two of the biggest teaching hospitals in Johannesburg, South Africa, from 15 February 2016 to 15 February 2020. The study included consecutive patients with confirmed sepsis who were admitted to the ICU within 24 hours of admission to hospital. The primary outcome of the study was development of SA-AKI (defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria), and secondary outcomes were risk factors for SA-AKI and predictors of mortality at 90 days. Multivariate logistic regression analysis was employed to determine the factors associated with SA-AKI and 90-day mortality.
Results. In total, 327 critically ill patients with sepsis admitted to the ICUs were included in the study. The median (interquartile range)
age was 39 (30 - 52) years, and 185 patients (56.6%) developed SA-AKI. Of these patients, blacks and whites comprised 91.0% and 6.1%,
respectively, and the prevalent comorbidities were HIV/AIDS (19.3%), hypertension (14.2%) and diabetes mellitus (10.1%). Patients with
SA-AKI were likely to be older and of male gender, and to have cardiovascular disease, malignancies, hypotension and a low serum albumin level. In multivariate analysis, the predictors of SA-AKI were age ≥55 years (odds ratio (OR) 2.43; 95% confidence interval (CI) 1.27 - 4.65), inotropic support (OR 3.61; 95% CI 2.18 - 5.96) and a low serum albumin level (OR 2.93; 95% CI 1.40 - 6.13). SA-AKI and need for inotropic support were respectively associated with 1.9-fold and 1.7-fold increased mortality at 90 days after ICU admission.
Conclusion. SA-AKI was found to be frequent in this study in two tertiary hospital ICUs in Johannesburg, and the need for inotropic
support predicted mortality after ICU admission.
References
Zarjou A, Agarwal A. Sepsis and acute kidney injury. J Am Soc Nephrol 2011;22(6):999-1006. https:// doi.org/10.1681/asn.2010050484
Alobaidi R, Basu RK, Goldstein RL, Bagshaw SM. Sepsis-associated acute kidney injury. Semin Nephrol 2015;35(1):2-11. https://doi.org/10.1016/j.semnephrol.2015.01.002
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005:294(7):813-818. https://doi.org/10.1001/ jama.294.7.813
Lopes JA, Fernandes P, Jorge S, et al. Long-term risk of mortality after acute kidney injury in patients with sepsis: A contemporary analysis. BMC Nephrol 2010;11(9):1471-2369. https://doi. org/10.1186/1471-2369-11-9
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348(16):1546-1554. https://doi.org/10.1056/nejmoa022139
Shum HP, Kong HH, Chan KC, Yan WW, Chan TM. Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors. Ren Fail 2016;38(5):706-716. https://doi.org/10.3109/0886022x.2016.1157749
Vachiat AI, Musenge E, Wadee S, Naicker S. Renal failure in HIV-positive patients – a South African experience. Clin Kidney J 2013;6(6):584-589. https://doi.org/10.1093/ckj/sft128
Aylward RE, van der Merwe E, Pazi S, et al. Risk factors and outcomes of acute kidney injury in South African critically ill adults: A prospective cohort study. BMC Nephrol 2019;20(1):460. https://doi. org/10.1186/s12882
Liu J, Xie H, Ye Z, Li F, Wang L. Rates, predictors, and mortality of sepsis-associated acute kidney injury: A systematic review and meta-analysis. BMC Nephrol 2020;21(1):318. https://doi.org/10.1186/ s12882-020-01974-8
Yokota LG, Sampaio BM, Rocha EP, et al. Acute kidney injury in elderly patients: Narrative review on incidence, risk factors, and mortality. Int J Nephrol Renovasc Dis 2018;11:217-224. https://doi. org/10.2147/ijnrd.s170203
Khuweldi MA, Skinner DL, de Vasconcellos K. The incidence and outcomes of patients with acute kidney injury in a multidisciplinary intensive care unit in Durban, South Africa. South Afr J Crit Care 2020;36(2):80-85. https://doi.org/10.7196/SAJCC.2020.v36i2.426
Madero M, Sarnak MJ. Creatinine-based formulae for estimating glomerular filtration rate: Is it time to change to chronic kidney disease epidemiology collaboration equation? Curr Opin Nephrol Hypertens 2011;20(6):622-630. https://doi.org/10.1097/mnh.0b013e32834ba210
Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39(2):165-228. https:// doi.org/10.1007/s00134-012-2769-8
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int 2012;2(Suppl 1):1-138. https://kdigo.org/ wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf (accessed 9 November 2022).
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13(10):818-829 https://doi.org/10.1097/00003246-198510000-00009
Wang X, Jiang L, Wen Y, et al. Risk factors for mortality in patients with septic acute kidney injury in
intensive care units in Beijing, China: A multicenter prospective observational study. Biomed Res Int
;2014:172620. https://doi.org/10.1155/2014/172620
Wang H, Ji X, Wang AY, et al. Epidemiology of sepsis-associated acute kidney injury in Beijing, China:
A descriptive analysis. Int J Gen Med 2021;14:5631-5649. https://doi.org/10.2147/ijgm.s320768
Bagshaw SM, George C, Bellomo R. Early acute kidney injury and sepsis: A multicentre evaluation.
Crit Care 2008;12(2):R47. https://doi.org/10.1186/cc6863
Yang S, Su T, Huang L, Feng L-H, Liao T. A novel risk-predicted nomogram for sepsis associated-acute
kidney injury among critically ill patients. BMC Nephrol 2021;22(1):173. https://doi.org/10.1186/
s12882-021-02379-x
Alobaidi R, Basu RK, Goldstein SL, Bagshaw SM. Sepsis-associated acute kidney injury. Semin Nephrol 2015;35(1):2-11. https://doi.org/10.1016/j.semnephrol.2015.01.002
Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23(4):1203-1210. https:// doi.org/10.1093/ndt/gfm744
Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA. Acute renal failure in patients with sepsis in a surgical ICU: Predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol 2003;14(4):1022-1030. https://doi.org/10.1097/01.asn.0000059863.48590.e9
Kane-Gill SL, Sileanu FE, Murugan R, Trietley GS, Handler SM, Kellum JA. Risk factors for acute kidney injury in older adults with critical illness: A retrospective cohort study. Am J Kidney Dis 2015;65(6):860-869. https://doi.org/10.1053/j.ajkd.2014.10.018
Dos Santos RP, Carvalho ARdS, Peres LAB. Incidence and risk factors of acute kidney injury in critically ill patients from a single centre in Brazil: A retrospective cohort analysis. Sci Rep 2019;9(1):18141. https://doi.org/10.1038/s41598-019-54674-1
Yu M-y, Lee SW, Baek SH, et al. Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study. PLoS ONE 2017;12(7):e0180750. https://doi.org/10.1371/journal.pone0180750
Aksoy R, Adademir T, Yilmaz E, et al. Is hypoalbuminemia a predictor for acute kidney injury after coronary bypass grafting in diabetes mellitus patients? Braz J Cardiovasc Surg 2019;34(5):565-571. https://doi.org/10.21470/1678-9741-2018-0291
Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE 2013;8(3):e59321. https://doi.org/10.1371/journal. pone.0059321
Wiedermann CJ, Joannidis M. Nephroprotective potential of human albumin infusion: A narrative review. Gastroenterol Res Pract 2015;2015:1-8. https://doi.org/10.1155/2015/912839
Wiedermann CJ. Hypoalbuminemia as surrogate and culprit of infections. Int J Mol Sci 2021;22(9):4496. https://doi.org/10.3390/ijms22094496
Bagshaw SM, Uchino S, Bellomo R, et al. Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2(3):431-439. https://doi.org/10.2215/ cjn.03681106
Aylward R, Merwe E, Pazi S, et al. Risk factors and outcomes of acute kidney injury in South African critically ill adults: A prospective cohort study. BMC Nephrol 2019;20(1):460. https://doi.org/10.1186/ s12882-019-1620-1627
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