The prevalence, associated factors and clinical outcomes of acute kidney injury among elderly patients admitted in medical wards of Princess Marina Hospital, Gaborone, Botswana.

Abstract

Background                                    

Acute Kidney Injury (AKI) is a major problem worldwide as it is associated with high morbidity and mortality. The picture is likely to be worse in geriatric population of developing countries due to associated comorbid conditions. This study describes the prevalence, associated factors and clinical outcomes of Acute Kidney Injury among elderly patients admitted at Princess Marina Hospital (PMH), Gaborone, Botswana.

Methods

A retrospective cross-sectional study involved elderly patients admitted in medical wards of Princess Marina Hospital in Gaborone, Botswana from 1^st March 2017 to 28^th February 2018.

Results

Almost a third, 261/871 (29.96%) of admitted elderly patients had AKI. Final analysis involved 631 retrieved records (242 records of AKI and 371 records without AKI). Mean age (standard deviation) of participants was 66.98 (11.86) years.  Male gender comprised 58.1% of participants. The factors independently associated with AKI were hypertension, heart failure, and liver failure, and sepsis, use of nephrotoxic drugs, polypharmacy and hypotension. About a fifth of patients, 50/242 (20.7%) with AKI, either recovered to normal or baseline serum creatinine before discharge. Over a third of participants did not recover to normal/ baseline serum creatinine at discharge; they comprised 96/242 (39.7%). Similarly, over a third of elderly patients with AKI, 96/242 (39.7%) died.  Serum potassium was significantly associated with AKI non-recovery to normal or baseline serum creatinine whereas age over 80 years, chronic lung disease, and higher creatinine level at AKI diagnosis were independently associated with high all-cause mortality.

Conclusions:

The prevalence of AKI among elderly patients admitted in medical wards of a referral hospital in Botswana is high and AKI is associated with a high all-cause mortality. There is a need to conduct a prospective multicenter observational study in Botswana to obtain findings that will help generalizability while at the same time establish long-term outcomes of patients discharged with impaired renal functions