Incidence, characteristics and prognosis of acute kidney injury in Cameroon: a prospective study at the Douala General Hospital

Figures & data

Figure 1. Incidence of AKI.

Table 1. General characteristics of AKI patients.

Variables	Total (%) N = 536	Male (%) N = 293	Female (%) N = 243	p
Age (years)
Mean ± SD	54.71 ± 18.41	55.53 ± 17.39	53.72 ± 19.56	.256
Unit of hospitalization
Internal medicine	407 (75.90)	230 (42.90)	177 (33.00)	.170
Intensive care unit	129 (24.10)	63 (11.80)	66 (12.30)
Length of hospital stay (IQ)
Median (IQ)	8 (1–41)	8 (1–39)	8 (1–41)	.909
Comorbidity
Hypertension	205 (32.20)	123 (19.30)	82 (12.90)	.059
Diabetes mellitus	112 (17.60)	64 (10.00)	48 (7.60)	.584
HIV	80 (12.60)	38 (5.90)	42 (6.70)	.152
Cancer	59 (9.30)	24 (3.80)	35 (5.50)	1.000
Hepatitis B/C	51 (8.00)	38 (5.90)	13 (2.10)	.003
Heart failure	47 (7.40)	26 (4.10)	21 (3.30)	.946
Known CKD	39 (6.10)	26 (4.10)	13 (2.00)	.096
Liver cirrhosis	22 (3.40)	16 (2.50)	6 (0.80)	.085
Gout	20 (3.10)	15 (2.30)	4 (0.80)	1.000
Systemic lupus	2 (0.30)	0 (0.00)	2 (0.30)	1.000

HIV: human immunodeficiency virus; CKD: chronic kidney disease.

Bold indicates the significant p values.

Table 2. Clinical and biological characteristics of the study population.

Variables	Total (%)	Male (%)	Female (%)	p
Urine dipstick on admission (n = 350)
Proteinuria	242 (43.50)	124 (22.30)	118 (21.20)	.067
Hematuria/hemoglobinuria	138 (24.80)	63 (11.30)	75 (13.50)	.003
Leucocyturia	140 (25.20)	51 (9.20)	89 (16.0)	<.001
Nitrites	36 (6.50)	12 (2.20)	24 (4.30)	.006
Specific gravity (n = 350)
Between 1010 and1020	85 (24.30)	41 (11.70)	44 (12.60)
>1020	167 (47.70)	108 (30.80)	59 (16.90)	.023
<1010	98 (28.00)	45 (12.90)	53 (15.10)
Urine output on admission (n = 437)
<100 ml/day	183 (41.80)	99 (22.60)	84 (19.20)	.047
100–500 ml/day	187 (42.80)	88 (20.10)	99 (22.70)
500–2500 ml/day	58 (13.30)	33 (7.60)	25 (5.70)
>2500 ml/day	9 (2.10)	7 (1.60)	2 (0.50)
Blood pressure (mmHg)
Hypotension	293 (54.70)	169 (31.50)	124 (23.20)	.350
Normal	184 (34. 30)	94 (17.50)	90 (16.80)
Hypertension	59 (11.00)	30 (5.60)	29 (5.40)
Biology (mean ± SD)
Urea (n = 536)	1.29 ± 0.89	1.29 ± 0.97	1.28 ± 0.78	.976
Creatinine (n = 536)	48.44 ± 52.76	47.25 ± 53.94	49.89 ± 51.38	.565
Hemoglobin (n = 531)	9.49 ± 2.98	9.77 ± 3.17	9.15 ± 2.69	.016
White blood count (n = 531)	12.98 ± 21.15	12.97 ± 23.48	12.99 ± 17.99	.988
CRP (n = 449)	147.77 ± 112.68	146.03 ± 104.91	149.88 ± 121.65	.727
Sodium (n = 499)	136.78 ± 9.27	136.72 ± 8.23	136.86 ± 9.80	.626
Potassium (n = 499)	4.53 ± 1.25	4.52 ± 1.19	4.54 ± 1.31	.861
Bicarbonate (n = 83)	18.57 ± 6.72	18.93 ± 7.41	18.18 ± 7.41	.614

CRP: C-reactive protein.

Bold indicates the significant p values.

Table 3. Nature, mechanism, severity and etiology of AKI amongst participants.

Variables	Total (%)	Male (%)	Female (%)	p
Nature
Community acquired	500 (93.30)	278 (51.90)	222 (41.40)	.099
Hospital acquired	36 (6.70)	15 (2.80)	21 (3.90)
Mechanism
Pre renal	329 (61.40)	195 (36.40)	134 (25.00)	.004
Acute tubular necrosis	155 (28.90)	84 (15.70)	71 (13.20)
Glomerular	6 (1.10)	2 (0.40)	4 (0.70)
Interstitial	14 (2.60)	3 (0.60)	11 (2.00)
Vascular	10 (1.90)	3 (0.60)	7 (1.30)
Obstructive	22 (4.10)	6 (1.10)	16 (3.00)
Severity AKI
1	176 (32.80)	114 (21.30)	62 (11.50)	.005
2	128 (23.90)	65 (12.10)	63 (11.80)
3	232 (43.30)	114 (21.30)	118 (22.00)
Etiologies
Sepsis/bacterial infection	310 (50.40)	173 (28.10)	137 (22.30)
Volume depletion	195 (31.60)	109 (17.70)	86 (13.90)
Nephrotoxins	62 (10.10)	40 (6.50)	22 (6.40)
Obstruction	22 (3.60)	5 (0.80)	17 (2.80)
Eclampsia/HELLP	11 (1.80)	0 (0.00)	11 (1.80)
Multiple Myeloma	5 (0.80)	3 (0.50)	2 (0.30)
Malignant hypertension	5 (0.80)	3 (0.30)	2 (0.20)
Systemic lupus	3 (0.50)	0 (0.00)	3 (0.50)
Lymphoma	1 (0.20)	1 (0.20)	0 (0.00)
Unknown	1 (0.20)	1 (0.20)	0 (0.00)

Bold indicates the significant p values.

Table 4. Causes of sepsis/bacterial infection, volume depletion and obstruction amongst the study population.

Variables	Total (%)	Male (%)	Female (%)	p
Sepsis/bacterial infection	350	190 (54.30)	160 (45.70)
Urinary	88 (25.10)	40 (11.40)	48 (13.70)
Digestive	75 (21.50)	47 (13.40)	28 (8.10)
Pulmonary	64 (18.30)	38 (10.90)	26 (7.40)	.403
Unknown origin	49 (14.00)	30 (8.60)	19 (5.40)
Cutaneous	37 (10.60)	19 (5.40)	18 (5.20)
Meningitis	18 (5.10)	5 (1.40)	13 (3.70)
Septicemia	13 (3.70)	9 (2.60)	4 (1.10)
Gynecology	4 (1.10)	0 (0.00)	4 (1.10)
Endocarditis	1 (0.30)	1 (0.30)	0 (0.00)
Chronic otitis	1 (0.30)	1 (0.30)	0 (0.00)
Volume depletion	203	112 (55.20)	91 (44.80)
Hemorrhage	48 (23.70)	27 (13.30)	21 (10.40)
Gastroenteritis	47 (23.10)	26 (12.70)	21 (10.40)
Diabetes mellitus	44 (21.70)	21 (10.40)	23 (11.30)	.701
Heart failure	36 (17.70)	19 (9.40)	17 (8.30)
Liver cirrhosis	14 (6.80)	9 (4.40)	5 (2.40)
Diuretics	6 (2.90)	5 (2.40)	1 (0.50)
Burn	4 (2.00)	3 (1.50)	1 (0.50)
Intestinal occlusion	2 (1.00)	1 (0.50)	1 (0.50)
NSAID	1 (0.50)	1 (0.50)	0 (0.00)
Unspecified	1 (0.50)	0 (0.50)	1 (0.00)
Obstructive AKI	22	5 (22.70)	17 (77.30)
Pelvic tumor	18 (81.80)	5 (22.70)	13 (59.10)
Cervical cancer	13 (2.10)	0 (0.00)	13 (2.10)
Prostate cancer	4 (0.70)	4 (0.70)	0 (0.00)
BPH	1 (0.20)	1 (0.20)	0 (0.00)	.004
Ureters ligation	2 (9.20)	0 (0.00)	2 (9.20)
Retroperitoneal ibrosis	1 (4.50)	0 (0.00)	1 (4.50)
Renal stones	1 (4.50)	0 (0.00)	1 (4.50)

NSAID: non-steroidal anti-inflammatory drugs; BPH: benign prostatic hyperplasia.

Bold indicates the significant p values.

Table 5. Nephrotoxins and obstetrical/gynecological causes of AKI amongst study population.

Variables	Total (%)	Male (%)	Female (%)	p
Nephrotoxins	62 (100%)	40 (64.50)	22 (35.50)	.836
Herbal remedies	20 (32.30)	13 (21.00)	7 (11.30)
Unspecified drugs	11 (17.80)	7 (11.30)	4 (6.50)
Rhabdomyolysis	9 (14.50)	7 (11.30)	2 (3.20)
Black water fever	8 (12.90)	6 (9.70)	2 (3.20)
Tumor lysis syndrome	5 (8.10)	3 (4.90)	2 (3.20)
Hemolysis, others	3 (4.80)	1 (1.60)	2 (3.20)
Iodine contrast product	3 (4.80)	2 (3.20)	1 (1.60)
Amphotericine B	2 (3.20)	0 (0.00)	2 (3.20)
ACE inhibitors	1 (1.60)	1 (1.60)	0 (0.00)
Obstetric or gynecology causes	38 (100)	0 (0.00)	38 (100.00)
Cervical cancer	13 (34.20)	0 (0.00)	13 (34.20)
Eclampsia/HELLP	11 (28.80)	0 (0.00)	11 (28.80)
Post-partum hemorrhage	8 (21.10)	0 (0.00)	8 (21.10)
Septic abortion	2 (5.30)	0 (0.00)	2 (5.30)
Endometritis	2 (5.30)	0 (0.00)	2 (5.30)
Bilateral ureters ligation post   caesarian section	2 (5.30)	0 (0.00)	2 (5.30)

ACE: angiotensin converting enzyme.

Table 6. Management and outcomes of AKI patients.

Variables	Total (%)	Male (%)	Female (%)	p
Use of vasoactive drugs	71 (13.20)	39 (7.30)	32 (5.90)	.988
Blood transfusion	145 (27.10)	72 (13.50)	73 (13.60)	.202
Dialysis indication	54 (10.10)	26 (4.90)	28 (5.20)
Dialysis done	39 (7.30)	15 (2.30)	24 (5.00)	.296
Reasons for non-realization of dialysis (n = 15)
Inadequate equipment	10 (66.80)	7 (46.80)	3 (20.00)	1.000
Denial	3 (20.00)	3 (20.00)	0 (10.00)	1.000
Early death	2 (13.20)	1 (6.60)	1 (6.60)	1.000
Renal recovery at 3 months known (n = 354)
Complete recovery	298 (84.20)	158 (44.60)	140 (39.60)	.613
Partial recovery	52 (14.70)	30 (8.50)	22 (6.20)
No recovery	4 (1.10)	4 (1.10)	0 (0.00)
Unknown (n = 182)
Early death	137 (75.30)	78 (42.80)	59 (32.50)	.613
Loss to follow-up	45 (24.70)	23 (12.60)	22 (12.10)
Patients outcomes
Survival	269 (50.20)	144 (26.90)	125 (23.30)	.502
Death	198 (36.90)	112 (20.90)	86 (16.00)
Loss to follow-up	69 (12.90)	37 (6.90)	32 (6.00)

Table 7. Presumed causes of death in the study population.

Variables	Total n = 209	Male n = 112	Female n = 86	p
Presumed causes of death
Sepsis	119 (56.90)	67 (32.00)	52 (24.90)	.328
Multi organ dysfunction	22 (10.60)	11 (5.30)	11 (5.30)
Hemorrhage	19 (9.10)	11 (5.30)	8 (3.80)
Cancer	18 (8.60)	9 (4.30)	9 (4.30)
Liver cirrhosis	9 (4.30)	8 (3.80)	1 (0.50)
Pulmonary embolism	8 (3.80)	4 (1.90)	4 (1.90)
Cardiogenic shock	8 (3.80)	3 (1.40)	5 (2.40)
Absence of dialysis	5 (2.40)	3 (1.40)	2 (1.00)
Eclampsia	1 (0.50)	0 (0.00)	1 (0.50)