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Severity and Outcomes of Afro-Caribbean Patients Diagnosed with Community Acquired Acute Kidney Injury at an Institution in Jamaica



There is limited data on community-acquired acute kidney injury (CA-AKI) in low/middle-income countries. This retrospective study focussed on the prevalence, severity and outcomes of CA-AKI at an institution in Jamaica. The selected population was patients who attended the University Hospital of the West Indies between January 2015 and June 2015. Acquired kidney injury was diagnosed and staged by KDIGO criteria. Four hundred and thirty-two patients (4.22%) met the diagnostic criteria of acute kidney injury (AKI). Of these, 171 (39.6%) had stage I AKI, 110 (25.5%) had stage II and 151 (35.0%) had stage III. Certain underlying causes such as volume depletion, various infections and cardiac failure were most prevalent causes of CA-AKI. Among the underlying causes, volume depletion remained as the leading cause of CA-AKI. Patients who had underlying causes which required urgent medical attention are likely to achieve recognition of CA-AKI at an early stage (95% CI: 1.884, 2.128, p < 0.001). Volume depletion and cardiac failure significantly increased the risk of CA-AKI (OR. 2.037, 95% CI: 1.130, 1.651, p = 0.004 and OR, 1.759, 95% CI: 1.827, 1.982, p = 0.03), respectively. Ninety-four patients (21.8%) had incomplete and 46 patients (10.6%) had no renal recovery at ≥ 90 days. The majority of patients who achieved complete renal recovery were patients who had stage I AKI (90.1%). Fifty-two patients with CA-AKI (12%) required dialysis and most of them (86.5%) had stage III AKI. Stages I and II CA-AKI had better renal outcomes than stage III CA AKI (95% CI: 1.566, 1.875, p < 0.001). The 30-day mortality and 90-day mortality among the patients with CA-AKI were 6.3% and 7.4%, respectively. The severity of CA-AKI varies with underlying cause. Earlier medical attention may link with better renal recovery. Volume depletion and cardiac failure are significant risk factors for CA-AKI and volume depletion remains as the leading cause of CA-AKI. Adverse outcomes are more likely to occur in patients with Stage III CA-AKI.
11 Jan, 2017
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e-Published: 12 Jan, 2017
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