Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi
Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi
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DOI：
10.1186/s12882-017-0446-4
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发表时间：
2017-01-14
期刊：
影响因子：
2.3
通讯作者：
Dreyer, Gavin
中科院分区：
文献类型：
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作者：
Evans, Rhys D. R.;Hemmila, Ulla;Dreyer, Gavin
背景：低收入国家急性肾损伤(AKI)的流行病学数据很少。本研究的目的是确定马拉维社区获得性AKI的发生率、严重性、病因学和预后。方法：我们对2015年4月27日至7月17日在布兰太尔的一家三级医院的普通内科住院进行了前瞻性观察研究。所有患者在入院时都进行了血肌酐筛查；肌酐高于实验室参考范围的患者由肾脏内科小组进行治疗。结果：纳入892例患者；188例(21。1%)入院时有肾脏疾病，其中153人(17。2%)AKI(中位年龄41岁；58岁)。8%HIV血清阳性)。60.AKI的主要原因是败血症和低血容量血症133例(86。9%)病例，最常见的是胃肠炎(n=29；19。0%)和肺结核(n=18；11。8%)。Aki在117(76)是多因素的。5%)的患者；110例(71。9%)。住院死亡率为44例。AKI占4%，AKI占13%。如果没有肾脏疾病，则为9%(p<；0.0001)。63.2%肾功能恢复患者因持续性肾损伤出院。结论：急性肾损伤发生率为17。在马拉维，2%的住院患者病情严重，AKI导致住院死亡率显著增加。主要原因是感染和毒素相关，两者都有可能避免，也可以相对简单地治疗。迫切需要采取有效的干预措施，以减少世界这一地区可预防的急性呼吸道感染造成的年轻死亡。
Background: Epidemiological data on Acute Kidney Injury (AKI) from low-income countries is sparse. The aim of this study was to establish the incidence, severity, aetiology, and outcomes of community-acquired AKI in Malawi.Methods: We conducted a prospective observational study of general medical admissions to a tertiary hospital in Blantyre between 27th April and 17th July 2015. All patients were screened on admission with a serum creatinine; those with creatinine above laboratory reference range were managed by the nephrology team. Hospital outcome was recorded in all patients.Results: Eight hundred ninety-two patients were included; 188 (21 . 1%) had kidney disease on admission, including 153 (17 . 2%) with AKI (median age 41 years; 58 . 8% HIV seropositive). 60 . 8% of AKI was stage 3. The primary causes of AKI were sepsis and hypovolaemia in 133 (86 . 9%) cases, most commonly gastroenteritis (n = 29; 19 . 0%) and tuberculosis (n = 18; 11 . 8%). AKI was multifactorial in 117 (76 . 5%) patients; nephrotoxins were implicated in 110 (71 . 9%). Inpatient mortality was 44 . 4% in patients with AKI and 13 . 9% if no kidney disease (p < 0.0001). 63 . 2% of patients who recovered kidney function left hospital with persistent kidney injury.Conclusion: AKI incidence is 17 . 2% in medical admissions in Malawi, the majority is severe, and AKI leads to significantly increased in-hospital mortality. The predominant causes are infection and toxin related, both potentially avoidable and treatable relatively simply. Effective interventions are urgently required to reduce preventable young deaths from AKI in this part of the world.