title: Acute kidney injury is a powerful independent predictor of mortality in critically ill patients: a multicenter prospective cohort study from Kinshasa, the Democratic Republic of Congo.
abstract: Despite the growing incidence of acute kidney injury (AKI) worldwide, there is little data on the burden and outcomes of AKI in intensive care unit (ICU) in low resource settings. The present study assessed the incidence of AKI and its impact on mortality in ICU in Kinshasa (Democratic Republic of Congo).
  
  
  
  In a prospective cohort study, 476 consecutive critically ill patients (mean age 52 years, 57 % male) were screened for the presence of AKI in seven ICU from January 1st to March 30th, 2015. Serum creatinine was measured by the enzymatic method (Cobas C111 device®). AKI and its stages (no AKI, AKI 1, AKI 2 and AKI 3) were defined according to AKIN recommendations. The primary outcome was 28 days mortality. Survival (time-to death) curves were built using the Kaplan Meier methods. Predictors of mortality were assessed by Cox proportional hazards regression models. p < 0.05 defined the level of statistical significance.
  
  
  
  The cumulative incidence of AKI was 52.7 % with AKI stage 1, 2 and 3 in 23.7 %, 16.2 % and 12.8 % of patients, respectively. Among patients who developed AKI, 146 died (58 %) vs 62 patients (28 %) in the group without AKI. Only 6.5 % of the patients with AKI stage 3 benefited from dialysis. Median survival time was 15.0 days in patients without AKI and 3.0 days, 6.0 days and 8.0 days in patients with AKI stage 3, 2 and 1 (p < 0.001), respectively. In addition to respiratory distress-induced polypnea (HRa 1.60; 95 % CI: 1.08-2.37; p = 0.018), oxygen desaturation (HRa 1.53; 95 % CI: 1.13-2.08; p = 0.006) and multi-organic involvement (HRa 1.63; 95 % CI: 1.15-2.30), AKI emerged as an independent predictor of death (HRa 1.82; 95 % CI: 1.34-2.48; p < 0.001).
  
  
  
  More than half of critically ill patients in the present cohort developed AKI which contributed substantially to short-term mortality, highlighting the need for its prevention, early detection and management as well as the availability of dialysis in ICU.
authors.affiliation: Intensive Care Unit, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Angèle
authors.initials: A
authors.lastname: Masewu
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo. jrmakulo2016@gmail.com.
authors.forename: Jean-Robert
authors.identifier: 0000-0002-2258-1251
authors.initials: JR
authors.lastname: Makulo
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: François
authors.initials: F
authors.lastname: Lepira
authors.affiliation: Intensive Care Unit, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Eric Bibonge
authors.initials: EB
authors.lastname: Amisi
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Ernest Kiswaya
authors.initials: EK
authors.lastname: Sumaili
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.|Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Justine
authors.initials: J
authors.lastname: Bukabau
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Vieux
authors.initials: V
authors.lastname: Mokoli
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Augustin
authors.initials: A
authors.lastname: Longo
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Nlandu
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Engole
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Cedric
authors.initials: C
authors.lastname: Ilunga
authors.affiliation: Intensive Care Unit, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.|Intensive Care Unit, Centre Hospitalier de Monkole, Kinshasa, Democratic Republic of Congo.
authors.forename: Alphonse
authors.initials: A
authors.lastname: Mosolo
authors.affiliation: Intensive Care Unit, Hôpital Sino-Congolais de Kinshasa, Kinshasa, Democratic Republic of Congo.|Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Alex
authors.initials: A
authors.lastname: Ngalala
authors.affiliation: Intensive Care Unit, Hôpital Général Provincial de Référence de Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Justin
authors.initials: J
authors.lastname: Kazadi
authors.affiliation: Intensive care unit, Clinique Ngaliema, Kinshasa, Democratic Republic of Congo.
authors.forename: Richard
authors.initials: R
authors.lastname: Mvuala
authors.affiliation: Intensive care unit, Hôpital Biamba Marie Mutombo, Kinshasa, Democratic Republic of Congo.
authors.forename: Jackson
authors.initials: J
authors.lastname: Athombo
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Nkodila
authors.initials: N
authors.lastname: Aliocha
authors.affiliation: Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Pierre Zalagile
authors.initials: PZ
authors.lastname: Akilimali
authors.affiliation: Intensive Care Unit, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.|Intensive care unit, Clinique Ngaliema, Kinshasa, Democratic Republic of Congo.
authors.forename: Adolphe
authors.initials: A
authors.lastname: Kilembe
authors.affiliation: Nephrology unit, Department of internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Nazaire
authors.initials: N
authors.lastname: Nseka
authors.affiliation: Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Jadoul
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055815:Young Adult
keywords: Acute kidney injury; Black Africans; Incidence; Intensive care unit; Mortality