Clinical Features, Renal recovery and Predictors of Acute Kidney Injury in a Resource-Limited Country: A Prospective Study

Abstract Background Recovery from acute kidney injury (AKI) in hospitalized patients is variable and persistent impairment of renal function at discharge is associated with long-term adverse outcomes. Understanding the risk factors for non-recovery AKI may help to avoid modifiable determinants and enhance recovery. However, data on renal recovery and its associated factors is limited, especially in resource-limited settings. This study aimed to assess the clinical features, renal recovery, and predictors of AKI among hospitalized patients in Ethiopia. Methods A prospective observational study was conducted involving all adult patients with age ≥18 years, and met the kidney disease: improving global outcomes criteria for AKI from April to July 2019. The main outcome variable was renal recovery at discharge. The logistic regression model was used to determine predictors of non-recovery from AKI. Statistical significance was considered at a p-value of less than 0.05 on multivariate analysis. Results Of the 169 patients included in the study over four months, 127(75.2%) were < 60 years, 121 (71.6%) had kidney disease on admission, almost one-third (33.1%) of them had stage 3 AKI, nearly half (50.29%) had prerenal AKI, and 32(19%) had exposure to nephrotoxins. Vomiting 31(18.34%), oliguria 42(24%), hematuria 15(25.4%), and proteinuria 26(40.6%) were common presenting features. Of the total study participants, most of them (68%) had complete renal recovery and fifty-four (32%) patients had non-recovery AKI at the time of hospital discharge. On multivariable analysis, proteinuria (AOR 6.2, CI 1.25-31.4, p=0.002), AKI stage III (AOR 4.7, CI 1.37-28.6, p=0.019), and nephrotoxin exposure (AOR 5.2, CI 2.1-14.89, p=0.007) were factors significantly associated with non-renal recovery. Conclusions Our study found that most of the patients had AKI on admission and one-third had a higher stage of AKI. A higher proportion of patients were found to have non-recovery AKI at hospital discharge. Renal non-recovery was significantly associated with the severity of AKI, nephrotoxic drug use, and proteinuria. Follow-up of serum creatinine and proteinuria, and careful drug use monitoring may help to identify patients with poor prognosis, initiate specific interventions, and improve renal recovery.