Incidence of Acute Kidney Injury and its predictors among neonates admitted at neonatal intensive care unit, university of Gondar, Debretabor and Tibebe Ghion Amhara Region Comprehensive Specialized Hospitals, Northwest Ethiopia, 2023

Abstract Background: Although acute kidney injury is a major cause of neonatal morbidity and mortality worldwide, it is a serious problem in low and middle-income countries, particularly in sub-Saharan Africa such as Ethiopia. Moreover, there are few studies in developing countries. However, the aim of this study was to investigate the incidence and predictors of acute kidney injury in neonates admitted to the neonatal intensive care unit of some specialized hospitals in the Amhara region of northwestern Ethiopia. Methods: A facility-based retrospective follow-up study was conducted with 634 neonates from January 2020 to December 2022. Data were collected by reviewing patient charts using simple random sampling with a pretested checklist, entered using Epi-data 4.6, and analyzed using STATA 14. Median survival time, Kaplan-Meier survival curve, and log-rank test were calculated. Bivariable and multivariable Cox hazard models were used to determine the determinants of acute kidney injury. A hazard ratio with a 95% confidence interval was calculated. Variables with p-values less than 0.05 were considered statistically significant. Results: The proportion of acute kidney injury among neonates admitted to the three selected specialized neonatal intensive care units was (20.19%) (95% CI: 17.23-23.50) with an incidence of 14.9 per 1000 (95%CI: 12.5-17.7) neonates with sepsis (AHR: 2.59; 95%CI: 1.21-5.56), neonates with perinatal asphyxia [(AHR: 2.70; 95%CI: 1.29-5.65) were taking gentamicin drugs [(AHR=1.74; 95%CI: 1.03-2.94], were preterm [(AHR; 1.77: 95%CI: 1.05 -2.98], hyponatremia [(AHR: 2.14; 95%CI: (1.00 -4.9)] and hyperkalemia [(AHR: 2.64; 95 CI: (1.11- 6.2)] were found to be significant predictors of acute kidney injury. Conclusions: The incidence of acute kidney injury in neonates was high. Premature infants, neonates with sepsis, who suffered perinatal asphyxia, took gentamicin drugs, whose sodium levels decreased and potassium levels increased were at higher risk of developing acute kidney injury. All concerned agencies should work to prevent acute kidney injury and pay special attention to multifactorial causes. Therefore, strategies need to be developed and/or strengthened to prevent the occurrence of acute kidney injury in infants with sepsis, neonates who suffered perinatal asphyxia, and preterm infants whose sodium levels decreased and potassium levels increased.