Peri-Surgical Acute Kidney Injury in Two Nigerian Tertiary Hospitals: A Retrospective Study

The incidence and outcomes of acute kidney injury (AKI) are worse in developing countries due to late diagnosis, poor access and high cost of care. Surgical patients may have up to 10 fold increased risk for AKI due to complications arising from the primary surgical illness, peri-operative complications and treatment.

This study was a retrospective cross-sectional study of the epidemiology of AKI in two Nigerian tertiary institutions. Patients who had surgery during a 1year period were included. Patients' identification were obtained from the theatre registers, and relevant data collected from their hospital files. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria.

Two hundred and twenty patients were studied, and the majority were males (60.9%). Forty patients developed AKI (18.2%), with the majority in KDIGO stage 1 (12.7%). Mean age was 43.7±17.6 years compared to 37.2±21.7 years among those without AKI (mean difference=6.489, p=0.079). More males than females developed AKI (19.4% vs 16.3%, p=0.558). AKI was diagnosed in 38.5% of patients with sepsis compared to 16.9% of non-septic patients (p=0.061); in 23.9% of patients who had significant blood loss compared to 15.4% of patients without significant blood loss (p=0.128). Intensive care unit (ICU) admission was significantly commoner among patients with AKI (20% vs 7.8% p = 0.023). Mortality was 25% among patients who developed AKI compared to 7.2% in those without AKI (p=0.005) CONCLUSION: Patients diagnosed with AKI had a higher mean age. Perisurgical AKI was commoner in males, patients with sepsis, and those who lost significant blood intra-operatively. ICU admission and mortality were significantly higher among patients with AKI.