oa Wits Journal of Clinical Medicine - Epidemiology and outcomes of dialysis-requiring acute kidney injury at Chris Hani Baragwanath Hospital

Volume 1 Number 1
  • ISSN : 2618-0189
  • E-ISSN: 2618-0197



Background: Acute kidney injury (AKI) occurs commonly within the hospital setting and is associated with a high rate of morbidity and mortality. Factors such as social, economic and ethical dilemmas are closely associated with initiation of dialysis in the public health sector.

Methods: A retrospective review of 324 patients presenting with kidney failure who were initiated on acute dialysis at the Chris Hani Baragwanath Hospital was carried out over a 2-year period from July 2009 to June 2011.

Results: The mean age at presentation was 40 ± 13 years; 57% of patients were male and 92% were Black. HIV positivity occurred in 26% of patients. The leading indications for acute dialysis included decompensated chronic kidney disease (38.9%), acute tubular necrosis (ATN) (38.3%), HIV-related kidney disease (13.6%), malaria (5.7%), pregnancy-related kidney disease (7.4%) and glomerulonephritis (7.4%). ATN was the predominant cause of AKI in HIV-positive patients. The overall renal recovery rate was 31%, and the overall mortality rate was 23%. About 44.6% of patients had chronic consequences, with 23% being transferred to chronic renal replacement therapy (RRT) and 21.6% transferred to renal outpatients (ROPD) with cessation of dialysis; 1.4% were lost to follow-up. While HIV-positive patients had a better renal recovery rate compared to HIV-negative patients (36% versus 26%; p < 0.0001), they had a higher mortality rate compared to their HIV-negative counterparts (34% versus 19%; p < 0.0001).

Conclusion: AKI remains a common presentation that often requires dialysis, a precious resource in an already overburdened health system, and occurs at similar rates in HIV-positive and HIV-negative patients. The underlying aetiology of AKI at Chris Hani Baragwanath resembles that of other developing countries with ATN, malaria, sepsis and pregnancyinduced kidney injury amongst the leading causes. High mortality rates were observed in patients with ATN, in both HIV-positive and HIV-negative patients.

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