Abstract: FR-PO103

AKI in the Tertiary Care Setting in Rwanda: Three Month and One Year Outcomes after Hospital Discharge

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • McKnight, Marla D., Harvard Medical School, Boston, United States
  • Finkelstein, Fredric O., Yale University, New Haven, Connecticut, United States
  • Igiraneza, Grace, University of Rwanda, Kigali, Rwanda
Background

Despite a burgeoning body of literature regarding the epidemiology and outcomes of acute kidney injury (AKI) in low-income settings, there remains limited data regarding the medium to long-term outcomes of patients presenting with or sustaining AKI in hospital.

Methods

In this observational, multicenter study in Rwanda, all patients > age 15 who met KDIGO definition of AKI, based on changes in serum creatinine, while admitted at one of the four national tertiary care hospitals between September 1, 2014 and January 31, 2015 had demographic and clinical information collected and were followed up post hospital discharge at 3 months (+/- 30 days) and at one year (+/- 3 months) for decline in estimated glomerular filtration rate (GFR) by 30% from baseline and mortality. Logistic regression models were performed to determine predictors of progression and mortality at 3 months.

Results

Of the 427 patients having met criteria for AKI in hospital, 291 survived to discharge. At 3 months post hospitalization, 241 were accounted for and 199 had creatinine measured. 63 (31.7%) demonstrated a GFR decline of >30%. Patients with exposure to traditional medicines prior to hospitalization were at higher risk of progression to CKD at 3 months (OR 3.02, p=0.08), whereas those who recovered baseline kidney function in hospital were significantly less likely to experience a drop in GFR at 3 months (OR 0.31, p=0.001). Patients that underwent dialysis uniformly experienced a >30% decline in GFR at 3 months. All-cause mortality at 3 months was 14.9% and having TB (OR 3.52, p=0.05), cancer (OR 3.82, p=0.03) and receiving dialysis (OR 9.01, p=0.003) were significantly associated with death. At one year, 120 patients were followed up and 102 had creatinine measured. 33 (32.3%) had a decline of GFR >30% at 12 months--10 additional patients had a decline of GFR >30% who had not at 3 months and 7 recovered renal function to within 30% of baseline. At one year there were 13 additional deaths, 9 of which had a decline of GFR>30 at 3 months.

Conclusion

Patients who experience AKI in hospital are at high risk for progression to CKD at three months and at one year. The study underscores the importance of careful follow-up of patients with AKI after hospital discharge and reflects the difficulty of capturing longterm outcome data in low-resource settings.

Funding

  • Private Foundation Support