Clinical Profile and Outcome of Patients with Acute Kidney Injury Requiring Hemodialysis: Two Years’ Experience at a Tertiary Hospital in Rwanda

Introduction. Acute kidney injury (AKI) requiring renal replacement therapy is associated with high mortality. The study assessed the impact of the introduction of hemodialysis (HD) on outcomes of patients with AKI in Rwanda. Methods. A single center retrospective study that evaluated the clinical profile and survival outcomes of patients with AKI requiring HD [AKI-D] at a tertiary hospital in Rwanda. Data was collected on patients who received HD for AKI from September 2014 to December 2016. Patient demographics, comorbidities, clinical presentation, laboratory tests, and mortality were reviewed and analyzed. Predictors of mortality were assessed using age and gender adjusted multivariate analyses. Results. Of the 82 eligible patients, median age was 38 years (IQR 28–57 years). Males comprised 51% of the cohort. Infectious diseases including malaria, pneumonia, and sepsis (35.1%) and pregnancy-related conditions (26.9%) were the most frequent comorbidities. Pulmonary oedema (54.9%) and uremic encephalopathy (50%) were top indications for HD. Mortality was 34.1%. On multivariate analysis, receipt of <5 sessions of HD (OR = 4.01, 95% CI 1.185–13.61, P=0.026) and hyperkalemia (OR = 3.23, 95% CI 1.040–10.065, P=0.043) were associated with mortality. Conclusion. The availability of acute hemodialysis in Rwanda has resulted in improved patient survival and persistent hyperkalemia predicted higher mortality.

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Clinical profile of acute kidney injury in a tertiary hospital

Medpusle International Journal of Medicine ◽

10.26611/10211022 ◽

2019 ◽

Vol 10 (2) ◽

pp. 59-61

Author(s):

M Rama Subba Reddy ◽

◽

S Senthil Kumar ◽

A Nasreen Begum ◽

A Shanmuga Priya ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Tertiary Hospital ◽

Clinical Profile

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Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome

Journal of Renal and Hepatic Disorders ◽

10.15586/jrenhep.2020.75 ◽

2020 ◽

Vol 4 (2) ◽

pp. 21-28

Author(s):

Jonathan S Chávez-Iñiguez ◽

Jose Said Cabrera-Aguilar ◽

Guillermo Garcia-Garcia ◽

Juan Armendáriz-Borunda

Keyword(s):

Acute Kidney Injury ◽

Clinical Presentation ◽

Clinical Signs ◽

Kidney Injury ◽

Organ Damage ◽

Multiple Organ ◽

Serological Tests ◽

Microbiological Criteria ◽

Sanitary Conditions ◽

The Impact

Leptospirosis is considered a zoonosis acquired predominantly from contaminated surfaces and water, more commonly in emerging countries with limited sanitary conditions. Leptospira in the host unleashes an immune response that explains the symptoms and clinical signs; once it reaches the kidney and liver tissue, it can manifest with alterations that lead to acute and chronic diseases in both organs. Weil’s syndrome is the best known clinical manifestation with jaundice and acute kidney injury that could lead to multiple organ failure and death. For its diagnosis, there are simplified scores such as the SPiRO score, the microbiological criteria by microscopy or serological tests; the treatment focuses on antibiotics and, if necessary, provides organic support until the infection is curtailed. The purpose of this review was to address the impact of Lep-tospira infection on the kidney and liver, the mechanisms of organ damage, the clinical presentation, and diagnosis and management of this disease.

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Acute Kidney Injury Patterns Following Transplantation of Steatotic Liver Allografts

Journal of Clinical Medicine ◽

10.3390/jcm9040954 ◽

2020 ◽

Vol 9 (4) ◽

pp. 954 ◽

Cited By ~ 2

Author(s):

Caroline Jadlowiec ◽

Maxwell Smith ◽

Matthew Neville ◽

Shennen Mao ◽

Dina Abdelwahab ◽

...

Keyword(s):

Acute Kidney Injury ◽

Patient Survival ◽

Kidney Injury ◽

Allograft Survival ◽

Injury Patterns ◽

Initiation Of Dialysis ◽

One Year ◽

End Stage ◽

The Impact ◽

Macrovesicular Steatosis

Background: Steatotic grafts are increasingly being used for liver transplant (LT); however, the impact of graft steatosis on renal function has not been well described. Methods: A total of 511 allografts from Mayo Clinic Arizona and Minnesota were assessed. We evaluated post-LT acute kidney injury (AKI) patterns, perioperative variables and one-year outcomes for patients receiving moderately steatotic allografts (>30% macrovesicular steatosis, n = 40) and compared them to non-steatotic graft recipients. Results: Post-LT AKI occurred in 52.5% of steatotic graft recipients versus 16.7% in non-steatotic recipients (p < 0.001). Ten percent of steatotic graft recipients required new dialysis post-LT (p = 0.003). At five years, there were no differences for AKI vs. no AKI patient survival (HR 0.95, 95% CI 0.08–10.6, p = 0.95) or allograft survival (HR 1.73, 95% CI 0.23–13.23, p = 0.59) for those using steatotic grafts. Lipopeliosis on biopsy was common in those who developed AKI (61.0% vs. 31.6%, p = 0.04), particularly when the Model for End-Stage Liver Disease (MELD) was ≥20 (88.9%; p = 0.04). Lipopeliosis was a predictor of post-LT AKI (OR 6.0, 95% CI 1.1–34.6, p = 0.04). Conclusion: One-year outcomes for moderately steatotic grafts are satisfactory; however, a higher percentage of post-LT AKI and initiation of dialysis can be expected. Presence of lipopeliosis on biopsy appears to be predictive of post-LT AKI.

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Postoperative kidney injury does not decrease survival after liver transplantation

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502012001100010 ◽

2012 ◽

Vol 27 (11) ◽

pp. 802-808 ◽

Cited By ~ 2

Author(s):

Olival Cirilo Lucena da Fonseca-Neto ◽

Luiz Eduardo Correia Miranda ◽

Thales Paulo Batista ◽

Bernardo David Sabat ◽

Paulo Sérgio Vieira de Melo ◽

...

Keyword(s):

Liver Transplantation ◽

Acute Kidney Injury ◽

Orthotopic Liver Transplantation ◽

Multivariate Analyses ◽

Patient Survival ◽

Kidney Injury ◽

Term Survival ◽

Venovenous Bypass

PURPOSE: To explore the effect of acute kidney injury (AKI) on long-term survival after conventional orthotopic liver transplantation (OLT) without venovenous bypass (VVB). METHODS: A retrospective cohort study was carried out on 153 patients with end-stage liver diseases transplanted by the Department of General Surgery and Liver Transplantation of the University of Pernambuco, from August, 1999 to December, 2009. The Kaplan-Meier survival estimates and log-rank test were applied to explore the association between AKI and long-term patient survival, and multivariate analyses were applied to control the effect of other variables. RESULTS: Over the 12.8-year follow-up, 58.8% patients were alive with a median follow-up of 4.5-year. Patient 1-, 2-, 3- and 5-year survival were 74.5%, 70.6%, 67.9% and 60.1%; respectively. Early postoperative mortality was poorer amongst patients who developed AKI (5.4% vs. 20%, p=0.010), but long-term 5-year survival did not significantly differed between groups (51.4% vs. 65.3%; p=0.077). After multivariate analyses, AKI was not significantly related to long-term survival and only the intraoperative transfusion of red blood cells was significantly related to this outcome (non-adjusted Exp[b]=1.072; p=0.045). CONCLUSION: The occurrence of postoperative acute kidney injury did not independently decrease patient survival after orthotopic liver transplantation without venovenous bypass in this data from northeast Brazil.

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Incidence, Etiology, and Outcomes of Community-Acquired Acute kidney injury in Pediatric Admissions in Malawi

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00253 ◽

2018 ◽

Vol 38 (6) ◽

pp. 405-412 ◽

Cited By ~ 4

Author(s):

Rhys D.R. Evans ◽

Marie Docherty ◽

Anna Seeley ◽

Alison Craik ◽

Martha Mpugna ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Hospital Mortality ◽

Prospective Observational Study ◽

Causes Of Death ◽

Clinical Presentation ◽

Kidney Injury ◽

Tertiary Hospital ◽

The Other ◽

Immunodeficiency Virus

Background The epidemiology of acute kidney injury (AKI) in children in sub-Sahara Africa (SSA) is poorly described. The aim of this study was to establish the incidence, etiology, and outcomes of community-acquired AKI in pediatric admissions in Southern Malawi. Methods We conducted a prospective observational study of pediatric admissions to a tertiary hospital in Blantyre between 5 February and 30 April 2016. Children were screened for kidney disease on admission with measurement of serum creatinine and assessment of urine output. The clinical presentation, etiology, and management of children with AKI were documented. Results A total of 412 patients (median age 4 years, 52.6% male, and 7.5% human immunodeficiency virus [HIV] infected) were included in the study. Forty-five patients (10.9%) had AKI (Kidney Disease: Improving Global Outcomes [KDIGO] criteria), which was stage 3 in 16 (35.6%) patients. Sepsis and hypoperfusion, most commonly due to malaria ( n = 19; 42.2%), were the causes of AKI in 38 cases (84.4%). Three patients (6.7%) underwent peritoneal dialysis (PD) for AKI: 2 of them recovered kidney function, and the other one died. In-hospital mortality was 20.5% in AKI and 2.9% if no kidney disease was present ( p < 0.0001). Seventeen (47.2%) patients with kidney disease had persistent kidney injury on hospital discharge. Conclusion Acute kidney injury occurs in 10.9% of pediatric admissions in Malawi and is primarily due to infections, particularly malaria. Acute kidney injury results in significantly increased in-hospital mortality. Urgent interventions are required to eliminate preventable causes of death in this region.

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