RESUMEN
Introduction: Acute kidney injury (AKI) requiring renal replacement therapy is accompanied by considerable mortality. This present study evaluated predictors of mortality at initiation of hemodialysis (HD) in AKI patients in Goma (in the Democratic Republic of the Congo (DRC)). Methods: A single-centre cohort survey evaluated the clinical profile and survival rates of AKI patients admitted to HD in the only HD centre in Goma, North Kivu province (DRC). Data were collected from patients who underwent HD for AKI. Patient demographics, comorbidities, clinical presentation, laboratory tests, and mortality were reviewed and analyzed. The survival study used the Kaplan-Meier curve. Predictors of mortality were evaluated using Cox regression. Results: Of the 131 eligible patients, the mean age was 43.69 ± 16.56 years (range: 18-90 years). Men represented 54.96% of the cohort. The overall HD mortality rate was 25.19% (n = 33). In multivariate analysis, independent predictors of mortality in AKI stage 3 patients admitted to HD were as follows: age ≥ 60 years (adjusted hazard ratio (AHR) = 15.89; 95% CI: 3.98-63.40; p < 0.0001), traditional herbal medicine intake (AHR = 5.10; 95% CI: 2.10-12.38; p < 0.0001), HIV infection (AHR = 5.55; 95% CI: 1.48-20.73; p=0.011), anemia (AHR = 9.57; 95% CI: 2.08-43.87; p=0.004), hyperkalemia (AHR = 6.23; 95% CI: 1.26-30.72; p=0.025), respiratory distress (AHR = 4.66; 95% CI: 2.07-10.50; p < 0.0001), and coma (AHR = 11.39; 95% CI: 3.51-36.89; p < 0.0001). Conclusion: Initiation of hemodialysis with AKI has improved survival in patients with different complications.
RESUMEN
Acute kidney injury (AKI) is a complex condition that can occur in both community and hospital settings and has many aetiologies. These aetiologies may be infectious, toxic, surgical, or related to the different management methods. Although it is a major public health problem worldwide, it must be emphasised that both its incidence and mortality rate appear to be very high in sub-Saharan African (SSA) countries compared to developed countries. The profile of AKI is very different from that of more developed countries. There are no reliable statistics on the incidence of AKI in SSA. Infections (malaria, HIV, diarrhoeal, and other diseases), nephrotoxins, and obstetric and surgical complications are the main aetiologies in Africa. The management of AKI is costly and associated with high rates of prolonged hospitalisation and in-hospital mortality.
