The Association Between Acute Kidney Injury and Intensive Care Unit Mortality in a Resource-Limited Setting

Acute kidney injury (AKI) affects over 13 million people annually, with 85% of cases occurring in low- and middle-income countries. In sub-Saharan Africa, limited access to renal replacement therapy and constrained intensive care unit (ICU) capacity may contribute to disproportionately high AKI-related mortality. We evaluated the association between AKI and ICU mortality at a tertiary hospital in Malawi.

We conducted a retrospective analysis of ICU patients admitted to Kamuzu Central Hospital in Lilongwe, Malawi, from 2016 to 2018. Bivariate analyses and multivariable logistic regression were performed to assess factors associated with mortality, including AKI, defined as estimated glomerular filtration rate ≤ 60 mL/min/1.73 m² and oliguria less than 0.5 mL/kg/h of urine for greater than 6 h.

Of the 493 ICU patients included, 282 (57.2%) died. The median age was 29 y (interquartile range 19-38), and AKI was present in 105 patients (21.0%). Mortality was significantly higher among those with AKI compared to those without (79.0% versus 44.3%, P < 0.001). Multivariable logistic regression analysis revealed that AKI (adjusted odds ratio 5.12, 95% confidence interval 2.70-9.80, P < 0.001) was independently associated with increased mortality. Similarly, surgical patients with an AKI (adjusted odds ratio 9.06, 95% confidence interval 3.87-21.22, P < 0.001) were associated with increased mortality.

Timely recognition and management of AKI are critical to improving ICU outcomes, particularly for surgical patients in resource-limited settings. Expanding access to continuous dialysis and strengthening critical care infrastructure may improve survival for critically ill postoperative patients in low-resource environments.