Prevalence, associated factors and early clinical outcome of acute kidney injury among critically ill neonates admitted at Muhimbili National Hospital, Dar es salaam

Abstract

ABSTRACT Background Acute kidney injury (AKI) is an emerging public health problem globally; the burden of this condition in sub-Saharan Africa is not well documented particularly for neonates, infants, and children. Causes of AKI in neonates are several and include sepsis, and birth asphyxia; these are the leading causes of neonatal mortality globally. Critically ill neonates are at increased risk for AKI and timely diagnosis and management is crucial for their survival. Objectives To determine the prevalence, factors associated and early clinical outcome of AKI among critically ill neonates admitted at the Muhimbili National Hospital (MNH), Dar es Salaam. Methodology This was a cross-sectional study conducted at the MNH neonatal unit. Participants included critically ill neonates admitted from October 2017 to March 2018. Critically ill neonates were recruited consecutively. Data was collected using a standardized structured questionnaire. Blood samples were drawn for measuring serum creatinine (SCr) at admission, at the 72nd hour and at the 14th day. Data was analyzed using SPSS version 20.0 Univariate analysis was done using chi-square to determine the association between the different associated factors and AKI. Multivariate logistic regression was then used to determine the association between AKI and known associated factors found to be significant on univariate analysis. A p value of less than 0.05 was considered statistically significant. Results A total of 378 critically ill neonates were enrolled with predominance of males 59.8% (226 participants). The median age (Inter-Quartile Range) at admission was 3 (1, 6) days. The prevalence of AKI was 31.5%. Independent predictors of AKI were neonatal sepsis (aOR 2.237, 95%CI 1.3-3.6, P=0.001), severe pneumonia (aOR3.0, 95%CI 1.0-9.3, P=0.047) and usage of gentamycin (aOR6.8, 95%CI 1.3-9.3, P=0.02). Complete resolution of renal dysfunction at the fourteenth day was seen in 83.1% while 16.9% had persistence of renal dysfunction. Participants with AKI were noted to have significantly higher mortality 70.6% as compared to those without AKI 29.4% p-value of 0.000 Conclusion and Recommendations AKI is prevalent in critically ill neonates and has a high mortality rate. Early detection and management is critical in order to alleviate the morbidity and mortality associated with AKI.