FACTORS ASSOCIATED WITH OUTCOME OF RENAL REPLACEMENT THERAPY INITIATION AMONG PATIENTS WITH ACUTE KIDNEY INJURY ADMITTED TO INTENSIVE CARE UNITS AT REFERRAL HOSPITALS IN ADDIS ABABA, ETHIOPIA

Abstract

Abstract Background: Acute kidney injury (AKI) is common among patients admitted to the intensive care unit (ICU). It is an independent risk factor for morbidity and mortality There is uncertainty regarding the optimal time to initiate renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI). Objective: To assess the clinical profile and factors associated with outcome of renal replacement therapy in patients with acute kidney injury admitted to the intensive care unit at St. Paul’s Hospital Millennium Medical College (SPHMMC) and Zewditu Memorial Hospital (ZMH). Methods: A hospital based retrospective clinical records review was conducted among 140 critically ill AKI patients who underwent hemodialysis at SPHMMC and ZMH from January 1 2021 to December 31 2022. Records of the study population was assessed for completeness before data entry and the entered data was checked by investigator for incompleteness and/or inconsistency. Data was entered and analyzed with SPSS version 29. Binary and multivariable logistic regression analysis were employed to identify independent predictors of outcome of initiated renal replacement therapy. Statistical significance was declared at a P-value of < 0.05. Results: 140 patients required renal replacement therapy and the majority had sepsis 38(27.1%). The most common clinical factors associated with renal replacement therapy initiation were refractory fluid overload 55(38.6%), followed by uremic encephalopathy 54(37.9%). Renal replacement therapy was initiated at stage 3 of acute kidney injury in all of study participants. The composite outcome of death, dialysis dependence and diuretic dependence at intensive care unit (ICU) discharge was 81% and ICU mortality was 47.9%. Anuria (AOR=27.05, 95% CI: 8.06,90.73) and being on vasopressor (AOR=15.14 ,95% CI: 3.3,68.8) at the initiation of renal replacement therapy was associated with the outcome of ICU death. conclusion: The study population was young, predominantly female and with a relatively high burden of sepsis. The observed current threshold for renal replacement therapy was late (stage 3 acute kidney injury with classic/emergent indications). Patient with anuria and on vasopressor who were initiated on renal replacement therapy had high ICU death post renal replacement therapy.