Incidence, clinical patterns and outcomes of acute kidney injury among patients admitted with upper gastrointestinal bleeding at Benjamin Mkapa and Dodoma regional referral hospitals in Dodoma
| dc.contributor.author | Kimolo, Lioba Joseph | |
| dc.date.accessioned | 2024-03-27T11:54:03Z | |
| dc.date.available | 2024-03-27T11:54:03Z | |
| dc.date.issued | 2023 | |
| dc.description | Dissertation(MSc. Medicine) | |
| dc.description.abstract | Background; Acute kidney injury (AKI) is increasingly becoming a global health concern as it is linked to severe morbidity, death, longer hospital stays, and consequences such as chronic kidney disease, AKI has been documented to develop in 1–11.4% of patients with upper gastrointestinal bleeding (UGIB), this shows that AKI in UGIB may be a potent predictor of mortality. Objective: This study aimed at determining the incidence, Clinical pattern, and outcomes of acute kidney injury among patients admitted with upper gastrointestinal bleeding at tertiary hospitals in the Dodoma region. Methodology: A prospective longitudinal study was conducted among patients with upper gastrointestinal bleeding (UGIB) attending tertiary hospitals in Dodoma Tanzania between October 2022 and April 2023. Data on demographic and clinical characteristics were extracted and recorded in a questionnaire at baseline. Patients were evaluated for AKI using serum creatinine and urine output. AKI was assessed using KDIGO criteria at 48 hours and on the seventh day post-admission. Individuals who developed AKI were followed for 3 months for the occurrence of CKD. Data were descriptively and inferentially entered into a Microsoft Excel sheet and data analysis was done using SPSS version 27. Multivariable logistic regression analysis was used to identify factors associated with AKI. A P value of < 0.05 was considered statistically significant. Results; A total of 200 patients with UGIB were enrolled in the study with a median age of 62(IQR48-69) years, 59.5% were males. A total of 40(20%) patients presented with AKI of whom 31 (51.7%) had diabetes mellitus, 20(39.2%) had hypertension,15 (41.7%) had hepatitis B infection, and 4(21.1%) had schistosomiasis. The median creatinine was 89 (IQR78-107) umol/l, The median Hemoglobin was 5.9 (IQR 5-7.7) g/dl, The median Systolic Blood Pressure was 120 (IQR 97-142) MmHg, the median Diastolic Blood Pressure was 74 (IQR 60-91) MmHg. Variables with higher odds for AKI in UGIB patients include Advanced age ≥60 years [AOR=2.763, 95%CI (1.52,14.674), P=0.023] , Hypertension [AOR 3.905, 95% CI (2.712,6.411), P=0.007], nephrotoxic medicines [AOR 3.16 95% CI (1.117,8.283), P=0.049] Hepatitis B infection [ AOR 4.849, 95% CI (3.879,9.197), P=0.001], Variceal bleeding [OR at 95%CI=2.2(1.088,4.449), P=0.049], Diabetes mellitus [ AOR 1.075, 95% CI (1.015,1.381), P=0.002],Use of local herbs [AOR 1.255, 95% CI (1.010,1.421),P =0.029 Schistosomiasis [AOR 1.373, 95% CI vii (1.039,2.607),P=0.0394], and a longer Hospital stay (7-21 days)[AOR at 95% CI= 13.89(3.13,62.50), P=0.001]. After three months of follow up, out of 40 patients with AKI, 13 (32.5%) developed chronic kidney disease, Patients with AKI stage 3 were more likely to develop CKD 3(37.5%), and death 4(50%), with P=0.048. Conclusion; Acute Kidney injury is prevalent among patients hospitalized with upper gastrointestinal bleeding in our settings. Patients who presented with AKI had other co-morbidities like diabetes mellitus, hypertension, hepatitis B infection, and schistosomiasis, and had increased risks of developing AKI, progressing to CKD, and death. | |
| dc.identifier.citation | Kimolo, L. J. (2023). Incidence, clinical patterns and outcomes of acute kidney injury among patients admitted with upper gastrointestinal bleeding at Benjamin Mkapa and Dodoma regional referral hospitals in Dodoma (Master's dissertation). The University of Dodoma. | |
| dc.identifier.uri | https://repository.udom.ac.tz/handle/20.500.12661/4406 | |
| dc.language.iso | en | |
| dc.publisher | The University of Dodoma | |
| dc.subject | Acute kidney injury | |
| dc.subject | AKI | |
| dc.subject | Kidney disease | |
| dc.subject | gastrointestinal bleeding | |
| dc.subject | Benjamin Mkapa hospital | |
| dc.subject | Dodoma | |
| dc.title | Incidence, clinical patterns and outcomes of acute kidney injury among patients admitted with upper gastrointestinal bleeding at Benjamin Mkapa and Dodoma regional referral hospitals in Dodoma | |
| dc.type | Thesis |