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Kidney Week

Abstract: FR-PO038

In-Hospital Mortality of AKI in Those with and Without HIV at a Tertiary Hospital in South Africa: A 2-Year Retrospective Cohort Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ramsunder, Nikash N., University of Stellenbosch, Durban, South Africa
  • Chothia, Mogamat-Yazied, Tygerberg Academic Hospital, Cape Town, Western Cape, South Africa
Background

Acute kidney injury (AKI) in HIV patients in Sub-Saharan Africa is a common cause for hospitalisation and is associated with high morbidity and mortality. There is a paucity of comparative epidemiological data regarding the outcome of AKI in those with and without HIV from the African continent. The primary outcome was to determine the overall in-hospital mortality of AKI.

Methods

This was a single centre study of all consecutive adult patients with AKI referred to the renal unit at Tygerberg Hospital for the period from 1 January 2015 to 31 December 2016. AKI was defined as a recent normal serum creatinine (< 3 months) and/or normal kidney sizes on ultrasound examination (> 100 mm length). Those with proteinuria > 3.0 g/day were excluded. Kaplan Meier curves and logistic regression were used to assess survival and identify factors predicting mortality.

Results

We identified a total of 291 patients with AKI of which 116 (39.9%) were HIV positive. Overall, 91 (31%) patients died of which 40 (34.5%) were HIV positive and 51 (29.1%) were HIV negative (P = 0.34). At hospital admission, more HIV positive patients had tuberculosis (81.5% vs. 18.5%, P < 0.01) and had higher admission serum creatinine (551.1 umol/L vs. 190 umol/L , P < 0.01). Of those that died, the HIV positive patients were younger (41 years vs. 52 years, P < 0.01), were predominantly Black (87.5% vs. 23.5%, P < 0.01) and were predominantly admitted to medical wards (92.5% vs. 41.2%, P < 0.01). There was no difference in mortality regardless of renal replacement therapy (P = 0.50). Logistic regression identified Mixed race (OR 2.47, P = 0.02), HIV (OR 2.69, P < 0.01) and surgical ward admission (OR 2.05, P = 0.03) as strong predictors for death.

Conclusion

Overall in-hospital mortality of AKI was high. HIV was associated with a greater risk of death that may be the result of late presentation of both the AKI as well as the HIV.