Acute kidney injury among adult patients admitted with critical illness in tertiary hospitals in Dodoma

Acute kidney injury among adult patients admitted with critical illness in tertiary hospitals in Dodoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Acute kidney injury among adult patients admitted with critical illness in tertiary hospitals in Dodoma Titus Danda, Emmanuel Sindato, Alfred Meremo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8779910/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: The incidence of acute kidney injury (AKI) is highest in low and middle income countries despite the International Society of Nephrology (ISN) 0 by 2025 initiative. Critically ill patients are at increased risk for developing AKI, chronic kidney disease (CKD), end stage renal disease and death. Methodology : A prospective observational study was conducted among critically ill patients attending tertiary hospitals in Dodoma between October 2023 and May 2024. At baseline, patients’ demographic and clinical data were collected and laboratory investigations were performed to evaluate AKI. Patients were evaluated for AKI using the KDIGO criteria at baseline, 48 hours, on the 7th day and eGFR was calculated after 3 months using CKD-EPI equation. Atatistical analyses were conducted with SPSS (version 27). Logistic regression analyses were used to identify factors associated with AKI among critically ill patients and cox proportional hazard was used to determine predictors of mortality. Results: A total of 303 critically ill patients were enrolled into the study with a median age of 45 (IQR 32–65) years and 54.8% were male. On admission; the median serum creatinine was 101(89–155)µmol/L and the median haemoglobin was 13(9–14) g/dl. The incidence of AKI among critically ill patients was 49.5% (150/303). Factors associated with AKI included; HFheart failure [OR 5.3, 95% CI (1.34–21.1), P = 0.018], use of local herbs [OR 4.7, 95% CI (1.53–14.33), P = 0.007], malignancy [OR 4.5, 95% CI (1.53-13.0), P = 0.006], obstetric complications [OR 3.69, 95% CI (1.25–10.88), P = 0.018 ], illness severity [OR 2.57, 95% (CI 1.30–5.06), P = 0.006 ] and sepsis [OR 2.56, 95% (CI 1.18–5.55) P = 0.018 ]. Patients with AKI had longer mean hospital stays as compared to those without AKI(p < 0.01), 10% (15/150) developed CKD and 46.7% (70/150) died. Predictors of mortality were age [HR 2.1, 95% CI (1.25–3.5), p = 0.005 ] and AKI [HR 1.82, 95% (CI 1.16–2.87), p = 0.01 ]. Conclusion: The incidence of AKI and its associated mortality is high among adult patients admitted with critical illness in our settings. Use of local herbs, heart failure, severity of illness,malignancy, obstetric complications and sepsis were found to be strongly associated with AKI. Patients with AKI had longer mean hospital stays and almost half of the patients AKI died during hospitalization. Incidence Factors associeted Outcomes Acute kidney injury Critical illness Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Acute kidney injury (AKI) is frequent in adult patients, with highest incidence in low-income and middle-income countries ( 1 , 2 ). Acute kidney injury is associated with prolonged hospital stays, high healthcare costs, higher morbidity and mortality rates ( 3 , 4 ). Acute kidney injury in adults affects upto 10% − 20% of all hospital admissions ( 5 , 6 ). Acute kidney injury accounts up to 10% of those patients requiring renal replacement therapy (RRT) and has a 50 − 70% death rate ( 7 , 8 ). Acute kidney injury is commonly diagnosed in critically ill patients, occurring in up to 50% of patients admitted in the intensive care unist ( 9 , 10 ). The incidence of AKI in sub-Saharan Africa ranges from 33.3% to 40.4% among patients admitted in general wards to > 50% in patients admitted in intensive care units (ICUs) ( 11 , 12 ). The incidence of AKI in Tanzania was 55.3% among patients admitted in intensive care units (ICUs) ( 13 ). Studies have reported older age, male sex, diabetes mellitus, hypertension and underlying chronic kidney disease (CKD) as factors associated with AKI ( 14 , 15 ). Sepsis, severity of the ilnnes, use of nephrotoxic drugs, heart failure (HF) and hemodynamic instability are associated with a higher incidence of AKI ( 13 , 16 ). Malignancies, HIV/AIDS, chronic liver diseases, hypoalbuminemia, multiple organ dysfunction and hypotension are frequently found in patients with AKI ( 17 , 18 ). Obstetric complications such as pre-eclampsia and hemorrhage are associated with AKI in critically ill pregnant and postpartum adult patients ( 19 – 21 ). Acute kidney injury in critically ill adult patients is associated with an increased risk of acute kideney disease( AKD), CKD, CKD progression, end-stage renal disease (ESRD) and death ( 18 , 22 , 23 ). Patients with AKI are at increased risk of CKD culminating into ESRD; CKD after AKI affects about 20% to 33% of the patients ( 24 – 26 ). Acute Kidney Injury is strongly associated with increased mortality; with AKI doubling the risk of hospital deaths ( 27 , 28 ). Acute kidney injury results into longer hospital stays, increased chances for hospital readmission after discharge, the need for renal replacement therapy (RRT) and higher healthcare costs( 29 , 30 ). The incidence of AKI and its associated mortality is highest in Africa with no reliable statistics despite the increased demand for RRT, longer hospital stays and increased mortality rates ( 14 , 31 ). There are few studies on the incidence, factors associated with and outcomes of AKI among adult patients admitted with critical illness. Methods Study design, population and settings: A prospective observational study was conducted among critically ill patients attending tertiary hospitals in Dodoma, Tanzania from October 2023 to May 2024 at the Dodoma Referral Regional Hospital (DRRH) and the Benjamin Mkapa Hospital. The Benjamin Mkapa Hospital and DRRH are tertiary hospitals in Dodoma with a bed capacity of 400 and 420 respectively. Both hospitals are teaching hospitals for the University of Dodoma (UDOM) and provide both specialized and super specialized healthcare to central and nearby zones of Tanzania. The study involved adult patients aged 18 yeras and above who were critically ill admitted in Intensive care units at Benjamin Mkapa Hospital and DRRH. Data collection and laboratory procedures: The sample size was obtained using Krejci Morgan sample size calculation (adapted from Marcelo et al 2019) which is used to determine the incidence for one population, the minimum required sample size of this study was 280 patients who were critically ill. Consecutive sampling technique was used to enroll patients with critical illness serially until the sample size was obtained. Baseline socio-demographic, clinical, and laboratory findings were collected and filled in a standardized questionnaire. Systolic and diastolic blood pressure were measured 3 times, the average of the second and third measurements was used ( 32 ). Blood for serum creatinine measurements was collected at baseline (admission), 48 hours, 7th day and after 3 months of follow up. These samples were sent to the laboratory analyzed using the isotope dilution mass spectrometry (IDMS) traceable assay. Patients were evaluated for AKI using the KDIGO criteria at baseline (admission), 48 hours and on the 7th day. Urethral catheter was inserted to measure the urine output for 6 hours after admission as per KDIGO Criteria ( 33 ). The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without using the African American correction factor ( 34 ). All participants were tested for HIV under the provider-initiated testing and counseling protocol using Rapid HIV antibody test as recommended by WHO and current Tanzania guideline. Hemoglobin level, WBC, Neutrophils, lymphocyte absolute counts and platelet levels using CELL-DYN Ruby system hematological analyzer (ABBOTT LABS, USA). Random blood glucose and Blood urea nitrogen were performed as per the standard operating procedures. Assessment of the severity of illness on admission to the ICU was done using the universal vital assessment (UVA) score at admission ( 35 ). Acute kidney injury (AKI) was defined according to KDIGO as an increase in serum creatinine of 0.3 mg/dl (26.5µmol/l) within 48 hours; or an increase in serum creatinine to 1.5 times baseline within the previous 7 days; or a urine volume of less than 0.5 ml/kg/h for 6 hours ( 36 , 37 ). Chronic kidney disease (CKD) was defined as persistent abnormality in kidney function with estimated glomerular filtration rate (GFR) < 60 mL/min/1.73 m ( 2 ) for 3 months or more, irrespective of cause ( 38 ). Data management and analysis: Data were entered into a Microsoft Excel sheet and cleaned. The analysis was done using SPSS version 27. Descriptive statistics were used to summarize demographic and clinical characteristics; continuous variables were reported as median with interquartile ranges. Discrete variables were reported as frequencies and proportions, Pearsons’s chi square test were used to test for association between two variables for normally distributed variables and Mann-Whitney U test for not-normally distributed variables. Binary logistic regression was performed to identify factors associated with AKI among critically ill patients using the crude and adjusted odds ratio (OR) with the 95% confidence interval (CI) for significant differences between the groups. Factors with p-value less than 0.2 on univariate logistic regression models were then fitted into the multivariate logistic regression models; factors with a p-value of less than 0.05 were considered to have significant strength of association. Cox proportional hazard was used to determine predictors of mortality. Results A total of 450 patients were admitted to ICUs during the study, of whom 143 (31.8%) were excluded; 104 (73%) were below 18 years, 12 (8.4%) due to readmission in ICU during the study period, 17(11.9%) were already on dialysis, 6 (4.2%) stayed in ICU of less than 24 hours, 4(2.8%) patients did not provide informed consent. A total of 303 (67.3%) patients with critical illness were recruited into this study; who were as assesed on admission, followed up at 48 hours and 7 days post admission to assess the development of acute kidney injury. A total of 150 patients developed AKI and were subsequently followed up at 3 months to determine if they recovered, developed CKD or death. After 3 months of follow up; 29 (19.3%) had AKI resolution, 36(24%) developed AKD, 15 (10%) developed CKD and 70 (46.7%) of the patients died ( Fig. 1 ). Demographic and baseline clinical characteristics A total of 303 critically ill patients were enrolled into the study with a median age of 45 (IQR 32–65) years and 54.8% were male. Most patients were from rural area 157 (51.8%) and majority of them 132 (43.6%) had primary level of education. Patients severity requiring ICU care and mechanical ventilation was determined by their Glasgow Coma Scale (GCS); 193 (47.7%) of the patients had mild score, 39 (12.9%) of the patients had modertate score, 71(23%) of the patients had severe score. The median Systolic blood pressure was 132(95–135) mmHg, the median diastolic blood pressure was 78(65–89) mmHg and Mean arterial pressure was 93(74–103) mmHg. The median serum creatinine was 101(89–155) µmol/L, the median haemoglobin was 13( 9 – 14 ) g/dl and the median white blood cells was 10 (7.2–16) x10 9 L (Table 1 ). Table 1 : Demographic and clinical characteristics of the ICU patients Reasons for ICU admissions The reasons for of ICU admissions included; 53(17.5%) with post operations, 51 (16.8%) with stroke, 31(10.2%) with road traffic accidents and 27 (9.6%) with malignancy ( Fig. 2 ). Universal Vital Assesment (UVA) Most, 144 (47.5%) of the patients admitted with critical illness had severe category of UVA score, 66 (21.8%) had moderate score and 93 (30.7%) had mild score. This pattern of UVA score shows that most of the patients were severely sick ( Fig. 3 ). . Clinical profile of patients with AKI A total of 150 (49.5%) patients developed AKI; 92 (61.3) of the patients had severe UVA score, 78 (52%) of the patients had anaemia, 50 (33.3%) of the patients had sepsis, 19 (27%) of the patients had Obstetric complications, 27 (18.0%) of the patients had malignancy, 17 (11.3%) had history of using local herbs and 13(8.7%) had HF (Table 2 ) Table 2 Clinical Profile of Study Participants by AKI Status VARIABLES AKI, N (%) NO AKI, N (%) P value Patient's age (Years) 18–39 56(37.3) 60(39.2) 0.37 40–59 42(28.0) 45(29.4) ≥ 60 52(34.7) 48(31.4) Gender Male 79(52.7) 87(56.9) 0.538 Female 71(47.3) 66(43.1) HIV/AIDS Negative Positive 143(95.3.) 7(4.7) 152(99.3) 1(0.7) 0.463 Mechanical ventilation No Yes 96(64.0) 54(36.0) 121(79.1) 32(20.9) 0.004 History of diabetes No Yes 128 (85.3) 22 (14.7) 119 (77.8) 34 (22.2) 0.09 Sepsis Yes 50(33.3) 22(14.4) 0.001 No 100(66.7) 131(85.6) Liver disease Yes 15(10.0) 16(10.5) 0.895 No 135(90.0) 137(89.5) History of hypertension Yes 56(37.3) 53(34.6) 0.625 No 94(62.7) 100(65.04 Malignancy Yes 27(18.0) 5(3.3) 0.001 No 123(82.0) 148(96.7) Obstetric complications Yes 19( 27 ) 5(7.6%) 0.009 No 52(73%) 57(92.4%) UVA score in category Mild 28(18.7) 38(24.8) 0.001 Moderate 30(20.0) 63(41.2) Severe 92(61.3) 52(34.00 Hb in category Anemia( 12g/dl) 72( 48 ) 106(69.3) HF Yes 13(8.7) 3( 2 ) 0.009 No 137(91.3) 150(98%) Herbal use Yes 17(11.3) 5(3.3%) 0.007 No 133(88.7) 148(96.7) Nephrotoxic medications Yes 18( 12 ) 5(3.3) 0.004 No 132(88) 148(96.7) Abbreviations; GCS –Glasgow coma score, UVA-Universal vital assessment score, MAP-Mean arterial pressure, HF-Congestive cardiac failure and WBC-White blood cells Risk factors for AKI among critically ill patients Patients were divided into two groups those with AKI and those without AKI. Nine potential variables were identified after performing univariable logistic regression analyses. Backward elimination reduced these to 8 parameters; Variables with higher odds for AKI after multivariable logistic regression analysis were: HF [OR 5.3, 95% CI (1.34–21.1), p = 0.018], use of local herbs [OR 4.68, 95% CI (1.53–14.33), p = 0.007 ], malignancy [OR 4.5,95% CI (1.53-13.0), p = 0.006], obstetric complications [OR 3.69, 95% CI (1.25–10.88), p = 0.018 ], Severe UVA score [OR 2.57, 95% CI (1.30–5.06), p = 0.006 ], sepsis [OR 2.56, 95% CI (1.18–5.55), p = 0.018 ], anaemia [OR 1.96, 95% CI (1.12–3.34), p = 0.029 ] and rural residency [OR 1.99, 95% CI (1.14–3.47), p = 0.016] (Table 3 ) Table 3 Risk factors for AKI among critically ill patients Variable Number (n) (%) Unadjusted OR [95% CI]P-Value Adjusted OR [95% CI] P-Value Residency Urban 63(42.0) Ref Rural 87(58.0) 1.64(1.04–2.58) 0.015 1.99(1.14–3.47) 0.016 UVA Score Mild (0–1) 28(18.7) Ref Moderate ( 2 – 4 ) 30(20.0) 2.4(1.324–4.353) 0.004 1.37(0.66–2.87) 0.402 Severe (> 4) 92(61.3) 4.97(2.44–10.11) 0.001 2.57(1.30–5.06) 0.006 Mechanical ventilation No 96(64.0) Ref Yes 54(36.0) 2.17(1.27–3.55) 0.04 1.1(0.533–2.09) 0.88 Sepsis No 100(66.7) Ref Yes 50(33.3) 2.9(1.69–5.2) 0.001 2.56(1.18–5.55) 0.018 HF No 137(91.3) Ref Yes 13(8.7) 4.8(1.3–17) 0.017 5.3 (1.34–21.1) 0.018 Malignancy No 133(88.7) Ref Yes 17(11.3) 6.5(2.43–17.4) 0.001 4.5(1.53-13.0) 0.006 Local herbs use No 139(92.7) Ref Yes 11(7.3) 3.8(1.36–10.54) 0.011 4.68(1.53–14.33) 0.007 Obstetric complication No 136(90.7) Ref Yes 18(9.3) 3.3(1.29–8.7) 0.013 3.69(1.25–10.88) 0.018 Anaemia No 72(48.0) Ref Yes 78(52.0) 2.4(1.528-3.9) 0.001 1.96(1.12–3.44) 0.019 Nephrotoxic medications No 132(88.0) Ref Yes 18(12.0) 4.0(1.458–11.174) 0.007 1.59(0.47–5.3) 0.877 Diabetes No 22(14.7) Ref Yes 128(85.3) 0.87(0.533–1.38) 0.559 0.511(0.25–1.06) 0.07 Gender Female 79(52.7) Ref Male 71(47.3) 0.8(0.54–1.3) 0.46 1.0(0.51–1.58) 0.71 Outcomes of AKI among patients admitted with critical illness Patients with AKI had longer mean hospital stay of 12 days as opposed to 8 days in non AKI cases (Fig. 4 ) (p < 0.01). Of the patients who had AKI, 29 (19.33%) had AKI resolution, 36(24%) developed AKD, 15 (10%) developed CKD and 70 (46.7%) died (Fig. 5 ). Predictors of all-cause mortality among critically ill patients After running univariable cox proportional hazard, 8 factors were found to be associated with mortality after 3 months follow up. They were then subjected into multivariable cox proportional hazard of which old age and AKI were found to be independent predictors of mortality among the study participants. Where for every unit increase in age there was 2.1 more likelihood of dying [HR 2.1, 95% CI (1.25–3.5), p = 0.005 ]. Also, patients with AKI were 1.8 more likely to die as compared to those with no AKI [HR 1.82, 95% (CI 1.16–2.87), p = 0.01 ] (Table 6 ). Table 6 Predictors of All-cause Mortality among patients with AKI (cox proportional Hazard. Variables Number (n) (%) Unadjusted OR [95% CI] P-value Adjusted OR [95% CI] P-Value Age ( 18 – 39 ) years 116(38.2) Ref (40–59) Years 87(28.7%) 2.074(1.23–3.49) 0.006 2.07(1.22–3.50) 0.007 (≥ 60) Years 100(33%) 2.28(1.38–3.76) 0.001 2.08(1.25–3.48) 0.005 UVA SCORE Mild (0–1) 66(21.8) Ref Moderate ( 2 – 4 ) 93(30.7) 0.807(0.423–1.54) 0.517 0.79(0.412–1.52) 0.479 Severe (> 4) 144(47.5) 1.94(1.137–3.31) 0.015 1.4(0.809–2.46) 0.226 Mechanical ventilation No 217(71.6)) Ref Yes 86(28.4) 1.538(1.03–2.30) 0.036 0.998(0.632–1.58) 0.993 Sepsis No 222(73.3) Ref Yes 81(26.7) 0.581(0.389–0.868) 0.008 1.20(0.73–1.96) 0.48 Malignancy No 271(89.4) Ref Yes 32(10.6) 2.22(1.35–3.66) 0.002 1.4(0.827-2.3) 0.210 Nephrotoxic medications No 280(92.4) Ref Yes 23(7.6) 0.474(0.27–0.834) 0.01 1.17(0.60–2.3) 0.642 AKI No 153(50.5) Ref Yes 150(49.5) 2.449(1.611–3.723) 0.001 1.82(1.16–2.87) 0.010 Patients without AKI were found to have better survival as opposed to patients with AKI Patients with AKI were found to have higher mortality as opposed to patients with no AKI Discussion This study evaluated the incidence, factors associated with and outcomes of AKI among adult patients admitted with critical illness in tertiary hospitals in Dodoma. The incidence of AKI among adult patients admitted with critical illness in this study was 49.5%. Similar findings have been reported from previous studies where upto 50% of patients admitted with critical illness in intensive care units were found with AKI ( 9 , 10 , 39 ). This incidence is higher than the findings from previous studies that were conducted among critically ill patients in Uganda, Kingdom of Bahrain and Brazil where the incidence of AKI was 70 (95% CI 55–90) per 1000 person days of observation, 17.9% and 21.3% respectively ( 40 – 42 ). Our study findings are lower when compared to a previous study that was conducted in Tanzania where the incidence of AKI among patients admitted in ICUs was 55.3% ( 13 ). Also, the incidence of AKI was reported to be > 50% in patients admitted in intensive care units worldwide including in developing countries ICUs ( 11 , 12 ). These differences could be accounted by geographical and population variations in the studies. Patients admitted with severe illness are at increased risk of developing AKI. Most (61.3%) of the patients who had AKI in this study were admitted with severe UVA score and severe UVA score had 3-fold increased odds for AKI. Similar to findings from previous studies that reported majority of patients who developed AKI were found to be admitted in ICUs and were found to be severely ill ( 16 , 40 , 43 ). Adult patients admitted with malignancy have a high incidence of AKI. Few (18.0%) of the patients who had AKI were found with malignancy and being found with malignancy had 5-fold increased odds for AKI. Similar to findings from previous studies; adult patients admitted with malignancy experienced a high incidence of AKI ( 44 , 45 ). Acute kidney injury is a common complication in adult patients admitted with heart failure. In this study, few (8.7%) of the adult patients who had AKI were found with HF and HF had 5-fold increased odds for AKI. Similar to findings from previous studies that reported patients with HF who were admitted with critical ilness had increased risks for AKI ( 46 , 47 ). Patients admitted with sepsis are at higher risk for sepsis-associated AKI. One third (33.3%) of the patients admitted with critical ilness in this study were found with sepsis and sepsis had 3-fold increased odds for AKI. Similar findings have been reported from previous studies where most of the patients admitted with critical illness due to sepsis had AKI ( 17 , 41 , 48 ). Acute kidney injury is a common complication found in adult patients presenting with anemia and are critically ill. Most (52%) of the patients who had AKI presented with anaemia and anemia had 2-fold increased odds for AKI. Similar to findings from previous studies which did demonstrate anemia by itself especially in critical illness has higher chances of causing AKI( 18 , 24 ). Adult patients presenting with underlying obstetric complications are at increased risk for developing AKI. Almost one third (27%) of the patients who had AKI presented with obstetric complications and obstetric complications had 4-fold increased odds for AKI. Similar to findings from previous studies; Obstetric complications such as pre-eclampsia and hemorrhage are associated with AKI in critically ill pregnant and postpartum adult patients( 19 – 21 ). Local herbs and remedies are a significant cause of AKI particularly in developing countries like Tanzania. Few (11.3%) of the patients who had AKI had history of using local herbs and using local herbs had 5-fold increased odds for AKI. Similar to findings from previous studies; patients using local herbs had higher chances of developing AKI ( 15 , 49 ). Rural residency is associated with inequities like lack of early diagnosis and prevention of AKI. Most (58.0%) of the patients who had AKI were living in rural areas and riral residency had 2-fold increased odds for AKI. Similar to findings from previous studies; inequities in access to optimal care and preventative strategies contribute to increased risk for developing AKI in rural areas ( 50 , 51 ). Acute kidney injury in critically ill adult patients is associated with increased risks for AKD, CKD and death( 18 , 22 ). In this study almost half of the patient with AKI among those will critical illness died. Similar to findings from previous studies; AKI was strongly associated with increased mortality; with AKI doubling the risk of hospital deaths ( 3 , 52 ). Acute kidney injury in patients admitted with critical illness results into prolonged hospital stays. In this study, patients with AKI had longer mean hospital stay when compared to those patients wihout AKI. Similar to findings from previous studies that demonstrated that the presence of AKI is associated with increased length of hospital stay ( 30 , 53 ). Patients with AKI were 1.8 more likely to die as compared to those with no AKI. Similar to findings from previous; AKI is an independent predictor of mortality among critically ill patients ( 27 , 54 ). While advanced age tends to correlate with higher mortality rates; for every unit increase in age there was 2.1 more likelihood of dying. Similar to findings from previous which did demonstrate that AKI is a frequent complication in elderly critically-ill patients ( 27 , 55 ). The limitations of this study include: this study was conducted in two tertiary hospitals in Dodoma, Tanzania thus restricting its generalizability. Despite these limitations, this prospective observational study provides data on the incidence, factors associated with and outcomes of AKI among adult patients admitted with critical illness in tertiary hospitals in Dodoma. Conclusion The incidence of AKI and its associated mortality is high among adult patients admitted with critical illness in our settings. Use of local herbs, Congestive Cardiac Failure, severity of illness, malignancys, obstetric complications and sepsi were found to be strongly associated with AKI. Patients with AKI had longer mean hospital stays, few patients developed CKD and almost half of the patients with AKI died. This is a call for clinicians to prioritize and identify patients admitted with critical illness who are more likely to develop AKI and monitor them closely to minimize chances for them dying and progressing to CKD. Abbreviations AKI acute kidney injury AOR adjusted odd ratio BMH Benjamin Mkapa Hospital CI Confidence interval CKD chronic kidney diseases CKD-EPI chronic kidney disease epidemiology collaboration CVD cardiovascular diseases DBP diastolic blood pressure DRRH Dodoma Regional Referral Hospital eGFR estimated glomerular filtration rate ESRD end stage renal disease ICU Intensive care unit IQR Interquartile range HIV human immunodeficiency virus IDMS isotope dilution mass spectroscopy KDIGO kidney disease improving global outcomes LMICs Low and Middle-Income Countries NCDs non-communicable diseases RRT renal replacement therapy SBP systolic blood pressure UDOM University of Dodoma UGIB upper gastrointestinal bleeding SSA Sub-Saharan Africa WBC white blood cell count Declarations Ethics approval and consent to participate Ethical approval was obtained from the University of Dodoma research and ethics committee (reference number MA.84/261/ 02/A/65/28). Written informed consent was obtained from each of the participant before recruitment of study participants. Consent for publication Not required Competing interests The authors declare that they have no competing interests. Funding This study received no specific funding Author Contribution TJD; participated in original design of the study, collection of data, data analysis and manuscript writing; ES: participated in design of the study, data collection, data analysis and manuscript writing; AM: participated design of the study, data collection, data analysis and manuscript writing. All authors have read and approved the final manuscript. Acknowledgement Special thanks to members of staff at the BMH and DRRH for their assistance in making this study possible. Additional thanks to the members of the Department of Internal Medicine of the School of Medicine, The University of Dodoma for their technical assistance. In a special way, we thank all the patients who were critically ill and were admitted in ICUs of Both Benjamin Mkapa Hospital and Dodoma Regional Referral Hospitals who agreed to participate in this study. Data Availability Data cannot be shared publicly because of ethics policy of the University of Dodoma. Data are available to researchers who meet the relevant ethics criteria from the corresponding author upon reasonable request. References Ostermann M, Lumlertgul N, Jeong R, See E, Joannidis M, James M. Acute kidney injury. The Lancet. 2025;405(10474):241–56. Bikbov B, Fortino I, Leoni O, Nobili A, Tettamanti M. Burden of Acute Kidney Injury among Adult Hospital Patients in the Italian Lombardy Region: A 20-Year Real-World Data Analysis. Nephron. 2023;147(10):599–607. Esposito P, Cappadona F, Prenna S, Marengo M, Fiorentino M, Fabbrini P, et al. 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Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study. Renal failure. 2023;45(2):2263583. Mweene MD, Richards GA, Paget G, Banda J, Dickens C. Risk factors and outcomes of sepsis-associated acute kidney injury in intensive care units in Johannesburg, South Africa. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde. 2022;112(12):919–23. Gómez H, Chen X, Minturn JS, Saraiva IE, Hamahata N, Zaidi A, et al. Persistent severe acute kidney injury is a major modifiable determinant of outcome during critical illness. Intensive care medicine. 2025;51(3):542–55. Nelson-Piercy C, Srisawat N, Kashani K, Lumlertgul N, Murugan R, Rhee H, et al. Pregnancy-associated acute kidney injury — consensus report of the 32nd Acute Disease Quality Initiative workgroup. Nature Reviews Nephrology. 2025;21(9):633–46. Berhe E, Teka H, Abraha HE, Abera BT, Gebru MA, Gebremariam T, et al. Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review. BMC Nephrology. 2024;25(1):182. Meena P, Das P, Auradkar A, Moideen A, Bhargava V, Kasturi U, et al. Pregnancy-associated acute kidney injury as an important driver of chronic kidney disease in females in developing countries: A systematic review. Maternal health, neonatology and perinatology. 2025;11(1):24. Zarbock A, Forni L, Koyner JL, Gómez H, Pannu N, Ostermann M, et al. Preventing acute kidney injury and its longer-term impact in the critically ill. Intensive care medicine. 2025;51(7):1331–47. Koh ES, Chung S. Recent Update on Acute Kidney Injury-to-Chronic Kidney Disease Transition. Yonsei medical journal. 2024;65(5):247–56. Diaz J, Lidon L, Sauri I, Fernandez A, Grau M, Gorriz JL, et al. The impact of acute kidney damage in the community. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2025;40(2):385–92. Wang X, He J, Wang Y. Long-term outcomes following acute kidney injury in individuals with pre-existing chronic kidney disease: a systematic review and meta-analysis. Journal of nephrology. 2025. Gameiro J, Gouveia B, Fonseca JA, Lopes JA. The burden of acute kidney disease: an epidemiological review and importance of follow-up care. Clinical kidney journal. 2025;18(6):sfaf169. Alba Schmidt E, De Rosa S, Müller J, Hüsing P, Daniels R, Theile P, et al. Acute kidney injury predicts mortality in very elderly critically-ill patients. European journal of internal medicine. 2024;127:119–25. Dutta A, Hari KJ, Azizian J, Masmoudi Y, Khalid F, Kowal JL, et al. Incidence, Predictors, and Prognosis of Acute Kidney Injury Among Cardiac Arrest Survivors. Journal of intensive care medicine. 2021;36(5):550–6. Havaldar AA, Sushmitha EAC, Shrouf SB, H. S M, N M, Selvam S. Epidemiological study of hospital acquired acute kidney injury in critically ill and its effect on the survival. Scientific Reports. 2024;14(1):28129. Muñoz-Sánchez A, Martín-Rodríguez L, López-Sánchez P, Valdenebro M, Serrano-Salazar ML, Marques M, et al. Intermediate and long-term AKI outcomes in a public health system. Journal of nephrology. 2025;38(7):1985–94. Melo FAF, Macedo E, Fonseca Bezerra AC, Melo WAL, Mehta RL, Burdmann EA, et al. A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries. PloS one. 2020;15(1):e0226325. Gupta A, Boucher R, Wei G, Gronseth G, Parks A, Beddhu S. Influence of Baseline Diastolic Blood Pressure on the Effects of Systolic Blood Pressure Lowering on Cognitive Function in Type 2 Diabetes Mellitus. American journal of hypertension. 2023;36(2):120–5. Fu J, Kosaka J, Morimatsu H. Impact of Different KDIGO Criteria on Clinical Outcomes for Early Identification of Acute Kidney Injury after Non-Cardiac Surgery. Journal of clinical medicine. 2022;11(19). Levey AS, Titan SM, Powe NR, Coresh J, Inker LA. Kidney Disease, Race, and GFR Estimation. Clinical Journal of the American Society of Nephrology. 2020;15(8):1203–12. Lal S, Luangraj M, Keddie SH, Ashley EA, Baerenbold O, Bassat Q, et al. Predicting mortality in febrile adults: comparative performance of the MEWS, qSOFA, and UVA scores using prospectively collected data among patients in four health-care sites in sub-Saharan Africa and South-Eastern Asia. EClinicalMedicine. 2024;77:102856. Bianchi NA, Stavart LL, Altarelli M, Kelevina T, Faouzi M, Schneider AG. Association of Oliguria With Acute Kidney Injury Diagnosis, Severity Assessment, and Mortality Among Patients With Critical Illness. JAMA Network Open. 2021;4(11):e2133094-e. Willner D, Goldman A, Azran H, Stern T, Kirshenbom D, Rosenthal G. Early identification of acute kidney injury in the ICU with real-time urine output monitoring: a clinical investigation. BMC nephrology. 2021;22(1):293. Chen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. Jama. 2019;322(13):1294–304. Melo FAF, Burdmann EA, Macedo E, Mehta R, Zanetta DMT. Acute kidney injury developed in the intensive care unit: a population-based prospective cohort study in the Brazilian Amazon. Scientific Reports. 2024;14(1):22954. Muhindo R, Kiptoo J, Tumuhimbise C, Nakyanzi C, Ssentongo FG, Kavubu M, et al. Incidence and Predictors of Acute Kidney Injury Among Critically Ill Adult Patients Admitted at Mbarara Regional Referral Hospital. International journal of nephrology and renovascular disease. 2025;18:201–13. ElSeirafi MMA, Hasan H, Sridharan K, Toorani MQ, Pasha SAA, Mohiuddin Z, et al. Acute kidney injury in critically ill adults: A cross-sectional study. International journal of critical illness and injury science. 2022;12(2):91–4. Inda-Filho AJ, Ribeiro HS, Vieira EA, Ferreira AP. Epidemiological profile of acute kidney injury in critically ill patients admitted to intensive care units: A Prospective Brazilian Cohort. Jornal brasileiro de nefrologia. 2021;43(4):580–5. Minja NW, Akrabi H, Yeates K, Kilonzo KG. Acute Kidney Injury and Associated Factors in Intensive Care Units at a Tertiary Hospital in Northern Tanzania. Canadian journal of kidney health and disease. 2021;8:20543581211027971. Shi Y, Chen G, Lu Z, Wang H, Xu J, Li Y, et al. Acute Kidney Injury in Hospitalised Cancer Patients: Incidence, Risk Factors and Outcomes. Nephrology (Carlton, Vic). 2025;30(4):e70025. Can W, Rong L, Lixia L. Incidence and risk factors of acute kidney injury in patients with malignant tumors: a systematic review and meta-analysis. BMC cancer. 2023;23(1):1123. Turkistani Y, Khateb F, Aboul-Enein F, Saddiqi G, Laimooniah D, Qari T, et al. Acute kidney injury in acute decompensated heart failure: clinical predictors and In-hospital outcomes at a tertiary center. Annals of medicine. 2025;57(1):2559126. Barua S, Chavali S, Vien A, Mahendran S, Makarious D, Lo P, et al. Acute kidney injury recovery status predicts mortality and cardiorenal outcomes in patients admitted with acute decompensated heart failure. Open heart. 2025;12(1). Patanwala AE, Erstad BL. Epidemiology of Septic Shock Associated Acute Kidney Injury: A National Retrospective Cohort Study. Critical care medicine. 2025;53(8):e1601-e9. Sethi J, Anandh U, Jha V. Nature's Cure or Kidney Curse? The Nephrotoxic Potential of Indigenous Remedies. Indian journal of nephrology. 2025;35(3):335–42. Xu F, Miyamoto Y, Zaganjor I, Onufrak S, Saelee R, Koyama AK, et al. Urban-Rural Differences in Acute Kidney Injury Mortality in the United States. American journal of preventive medicine. 2025;68(1):31–8. Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, et al. Inequities in kidney health and kidney care. Nature reviews Nephrology. 2023;19(11):694–708. Ostermann M, Lumlertgul N, Jeong R, See E, Joannidis M, James M. Acute kidney injury. Lancet (London, England). 2025;405(10474):241–56. Galván R, Fernandez-Riejos P, Sánchez Mora C, Salgueira Lazo M, Aguilera Morales W, Monzón A, et al. Early detection of acute kidney injury through an alert system improves outcomes in hospitalized patients. Clinica Chimica Acta. 2025;566:120061. Li S, Li Z, Li Y. Identification of risk factors and establishment of prediction models for mortality risk in patients with acute kidney injury: A retrospective cohort study. PloS one. 2024;19(10):e0312482. Makupa PC, Minja NW, Mkwizu E, Lyamuya FS, Shao ER, Thomas E, et al. Initial factors associated with in-hospital mortality in both critically ill and non-critically ill hospitalized patients with acute kidney injury in Northern Tanzania: a single center cohort study. Renal failure. 2025;47(1):2591255. 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Dodoma","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"","lastName":"Sindato","suffix":""},{"id":590030160,"identity":"bfa3d585-374f-41eb-9d1d-adaa74ee8ae9","order_by":2,"name":"Alfred Meremo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYBADGX4QmVBAghYeyQaQFgNStBgcAFHEaNFt73346EaFHY/x+dWJHx4YMMjzix3Ar8XszHFj45wzyTxmN95ulgA6zHDm7AQCWm6ksUnntjEDtZzdANKSYHCbkJb7z9h/57bV8xjPOLv5B3FabrCxMee2HeYx4O/dRqQtZ9KYpXPOHOeRuMG7zSLBQIIIvxw/xvg5p6Jajr//7OabPyps5PmlCWhBAAmwSglilYMA/wFSVI+CUTAKRsFIAgABHUFI+j1BGAAAAABJRU5ErkJggg==","orcid":"","institution":"the University Dodoma","correspondingAuthor":true,"prefix":"","firstName":"Alfred","middleName":"","lastName":"Meremo","suffix":""}],"badges":[],"createdAt":"2026-02-03 21:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8779910/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8779910/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102621137,"identity":"6ab3deda-1b7a-4f48-b547-53d81c6d6da7","added_by":"auto","created_at":"2026-02-13 16:47:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41946,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart diagram of enrolled patients with critical ilness.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/8c927961d14f232ff093f171.png"},{"id":102621138,"identity":"3a5b8bf4-5f6b-4847-bf6c-edd24c8b0d51","added_by":"auto","created_at":"2026-02-13 16:47:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":78944,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReason for ICU admission\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/c2f2b997b0ed8af8e5127d1b.png"},{"id":102621136,"identity":"465d0858-fad8-4675-b588-e4c1a66c83a9","added_by":"auto","created_at":"2026-02-13 16:47:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29639,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eUVA score category\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/6140b170c4739fd626ad6754.png"},{"id":102621140,"identity":"ceb666f5-8b44-4d3a-b804-a3597c8b6334","added_by":"auto","created_at":"2026-02-13 16:47:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":22930,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean hospital stay in days among patients admitted with critical illness\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/4e81cc991c7daf4352295e8f.png"},{"id":102621139,"identity":"99a5f152-6c6f-44ca-b147-9fbeb2cd7cb4","added_by":"auto","created_at":"2026-02-13 16:47:52","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":33070,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOutcomes of AKI among patients admitted with critical illness\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/a505bad11c48c0bff070ffcf.png"},{"id":102621142,"identity":"15848939-5b51-4d6e-938a-23250d656152","added_by":"auto","created_at":"2026-02-13 16:47:52","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":19787,"visible":true,"origin":"","legend":"\u003cp\u003eThe plot comparing survival rate between AKI and AKI free patients during 90 days follow up period.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/50950993930856a1bfc6f9a6.png"},{"id":102621141,"identity":"a6119f9c-265e-4647-a73d-721923a39c02","added_by":"auto","created_at":"2026-02-13 16:47:52","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":23646,"visible":true,"origin":"","legend":"\u003cp\u003eThe plot showing mortality was higher among AKI patients when compared to those with no AKI\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/4f8c0a8f295a589e26cd7c97.png"},{"id":102747352,"identity":"acc9ea9a-eb3a-47e2-9f88-f2422fabc687","added_by":"auto","created_at":"2026-02-16 09:04:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1883263,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8779910/v1/eb089e33-3beb-4001-8eda-a54f8f3b8e95.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Acute kidney injury among adult patients admitted with critical illness in tertiary hospitals in Dodoma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute kidney injury (AKI) is frequent in adult patients, with highest incidence in low-income and middle-income countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Acute kidney injury is associated with prolonged hospital stays, high healthcare costs, higher morbidity and mortality rates (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Acute kidney injury in adults affects upto 10% \u0026minus;\u0026thinsp;20% of all hospital admissions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Acute kidney injury accounts up to 10% of those patients requiring renal replacement therapy (RRT) and has a 50 \u0026minus;\u0026thinsp;70% death rate (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Acute kidney injury is commonly diagnosed in critically ill patients, occurring in up to 50% of patients admitted in the intensive care unist (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The incidence of AKI in sub-Saharan Africa ranges from 33.3% to 40.4% among patients admitted in general wards to \u0026gt;\u0026thinsp;50% in patients admitted in intensive care units (ICUs) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The incidence of AKI in Tanzania was 55.3% among patients admitted in intensive care units (ICUs) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies have reported older age, male sex, diabetes mellitus, hypertension and underlying chronic kidney disease (CKD) as factors associated with AKI (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Sepsis, severity of the ilnnes, use of nephrotoxic drugs, heart failure (HF) and hemodynamic instability are associated with a higher incidence of AKI (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Malignancies, HIV/AIDS, chronic liver diseases, hypoalbuminemia, multiple organ dysfunction and hypotension are frequently found in patients with AKI (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Obstetric complications such as pre-eclampsia and hemorrhage are associated with AKI in critically ill pregnant and postpartum adult patients (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAcute kidney injury in critically ill adult patients is associated with an increased risk of acute kideney disease( AKD), CKD, CKD progression, end-stage renal disease (ESRD) and death (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Patients with AKI are at increased risk of CKD culminating into ESRD; CKD after AKI affects about 20% to 33% of the patients (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Acute Kidney Injury is strongly associated with increased mortality; with AKI doubling the risk of hospital deaths (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Acute kidney injury results into longer hospital stays, increased chances for hospital readmission after discharge, the need for renal replacement therapy (RRT) and higher healthcare costs(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The incidence of AKI and its associated mortality is highest in Africa with no reliable statistics despite the increased demand for RRT, longer hospital stays and increased mortality rates (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). There are few studies on the incidence, factors associated with and outcomes of AKI among adult patients admitted with critical illness.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, population and settings:\u003c/h2\u003e \u003cp\u003e A prospective observational study was conducted among critically ill patients attending tertiary hospitals in Dodoma, Tanzania from October 2023 to May 2024 at the Dodoma Referral Regional Hospital (DRRH) and the Benjamin Mkapa Hospital. The Benjamin Mkapa Hospital and DRRH are tertiary hospitals in Dodoma with a bed capacity of 400 and 420 respectively. Both hospitals are teaching hospitals for the University of Dodoma (UDOM) and provide both specialized and super specialized healthcare to central and nearby zones of Tanzania. The study involved adult patients aged 18 yeras and above who were critically ill admitted in Intensive care units at Benjamin Mkapa Hospital and DRRH.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection and laboratory procedures:\u003c/h3\u003e\n\u003cp\u003e The sample size was obtained using Krejci Morgan sample size calculation (adapted from Marcelo et al 2019) which is used to determine the incidence for one population, the minimum required sample size of this study was 280 patients who were critically ill. Consecutive sampling technique was used to enroll patients with critical illness serially until the sample size was obtained. Baseline socio-demographic, clinical, and laboratory findings were collected and filled in a standardized questionnaire. Systolic and diastolic blood pressure were measured 3 times, the average of the second and third measurements was used (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBlood for serum creatinine measurements was collected at baseline (admission), 48 hours, 7th day and after 3 months of follow up. These samples were sent to the laboratory analyzed using the isotope dilution mass spectrometry (IDMS) traceable assay. Patients were evaluated for AKI using the KDIGO criteria at baseline (admission), 48 hours and on the 7th day. Urethral catheter was inserted to measure the urine output for 6 hours after admission as per KDIGO Criteria (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without using the African American correction factor (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e All participants were tested for HIV under the provider-initiated testing and counseling protocol using Rapid HIV antibody test as recommended by WHO and current Tanzania guideline. Hemoglobin level, WBC, Neutrophils, lymphocyte absolute counts and platelet levels using CELL-DYN Ruby system hematological analyzer (ABBOTT LABS, USA). Random blood glucose and Blood urea nitrogen were performed as per the standard operating procedures.\u003c/p\u003e \u003cp\u003eAssessment of the severity of illness on admission to the ICU was done using the universal vital assessment (UVA) score at admission (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Acute kidney injury (AKI) was defined according to KDIGO as an increase in serum creatinine of 0.3 mg/dl (26.5\u0026micro;mol/l) within 48 hours; or an increase in serum creatinine to 1.5 times baseline within the previous 7 days; or a urine volume of less than 0.5 ml/kg/h for 6 hours (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Chronic kidney disease (CKD) was defined as persistent abnormality in kidney function with estimated glomerular filtration rate (GFR)\u0026thinsp;\u0026lt;\u0026thinsp;60 mL/min/1.73 m (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) for 3 months or more, irrespective of cause (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData management and analysis:\u003c/h3\u003e\n\u003cp\u003eData were entered into a Microsoft Excel sheet and cleaned. The analysis was done using SPSS version 27. Descriptive statistics were used to summarize demographic and clinical characteristics; continuous variables were reported as median with interquartile ranges. Discrete variables were reported as frequencies and proportions, Pearsons\u0026rsquo;s chi square test were used to test for association between two variables for normally distributed variables and Mann-Whitney U test for not-normally distributed variables. Binary logistic regression was performed to identify factors associated with AKI among critically ill patients using the crude and adjusted odds ratio (OR) with the 95% confidence interval (CI) for significant differences between the groups. Factors with p-value less than 0.2 on univariate logistic regression models were then fitted into the multivariate logistic regression models; factors with a p-value of less than 0.05 were considered to have significant strength of association. Cox proportional hazard was used to determine predictors of mortality.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 450 patients were admitted to ICUs during the study, of whom 143 (31.8%) were excluded; 104 (73%) were below 18 years, 12 (8.4%) due to readmission in ICU during the study period, 17(11.9%) were already on dialysis, 6 (4.2%) stayed in ICU of less than 24 hours, 4(2.8%) patients did not provide informed consent. A total of 303 (67.3%) patients with critical illness were recruited into this study; who were as assesed on admission, followed up at 48 hours and 7 days post admission to assess the development of acute kidney injury. A total of 150 patients developed AKI and were subsequently followed up at 3 months to determine if they recovered, developed CKD or death. After 3 months of follow up; 29 (19.3%) had AKI resolution, 36(24%) developed AKD, 15 (10%) developed CKD and 70 (46.7%) of the patients died \u003cstrong\u003e(\u003c/strong\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDemographic and baseline clinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003eA total of 303 critically ill patients were enrolled into the study with a median age of 45 (IQR 32\u0026ndash;65) years and 54.8% were male. Most patients were from rural area 157 (51.8%) and majority of them 132 (43.6%) had primary level of education. Patients severity requiring ICU care and mechanical ventilation was determined by their Glasgow Coma Scale (GCS); 193 (47.7%) of the patients had mild score, 39 (12.9%) of the patients had modertate score, 71(23%) of the patients had severe score. The median Systolic blood pressure was 132(95\u0026ndash;135) mmHg, the median diastolic blood pressure was 78(65\u0026ndash;89) mmHg and Mean arterial pressure was 93(74\u0026ndash;103) mmHg. The median serum creatinine was 101(89\u0026ndash;155) \u0026micro;mol/L, the median haemoglobin was 13(\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e) g/dl and the median white blood cells was 10 (7.2\u0026ndash;16) x10\u003csup\u003e9\u003c/sup\u003eL (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Demographic and clinical characteristics of the ICU patients\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e\u003cimg 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\"\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eReasons for ICU admissions\u003c/h3\u003e\n\u003cp\u003eThe reasons for of ICU admissions included; 53(17.5%) with post operations, 51 (16.8%) with stroke, 31(10.2%) with road traffic accidents and 27 (9.6%) with malignancy \u003cstrong\u003e(\u003c/strong\u003eFig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUniversal Vital Assesment (UVA)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost, 144 (47.5%) of the patients admitted with critical illness had severe category of UVA score, 66 (21.8%) had moderate score and 93 (30.7%) had mild score. This pattern of UVA score shows that most of the patients were severely sick \u003cstrong\u003e(\u003c/strong\u003eFig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e .\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eClinical profile of patients with AKI\u003c/h2\u003e\n \u003cp\u003eA total of 150 (49.5%) patients developed AKI; 92 (61.3) of the patients had severe UVA score, 78 (52%) of the patients had anaemia, 50 (33.3%) of the patients had sepsis, 19 (27%) of the patients had Obstetric complications, 27 (18.0%) of the patients had malignancy, 17 (11.3%) had history of using local herbs and 13(8.7%) had HF (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical Profile of Study Participants by AKI Status\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVARIABLES\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAKI, N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNO AKI, N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePatient\u0026apos;s age (Years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60(39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.37\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52(34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79(52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87(56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71(47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV/AIDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143(95.3.)\u003c/p\u003e\n \u003cp\u003e7(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152(99.3)\u003c/p\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanical ventilation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96(64.0)\u003c/p\u003e\n \u003cp\u003e54(36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e121(79.1)\u003c/p\u003e\n \u003cp\u003e32(20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of diabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128 (85.3)\u003c/p\u003e\n \u003cp\u003e22 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (77.8)\u003c/p\u003e\n \u003cp\u003e34 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131(85.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135(90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137(89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of hypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94(62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100(65.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstetric complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52(73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57(92.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUVA score in category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38(24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63(41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92(61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52(34.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb in category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnemia(\u0026lt;\u0026thinsp;12g/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78(\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal Hb(\u0026gt;\u0026thinsp;12g/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72(\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106(69.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137(91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e150(98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHerbal use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e133(88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNephrotoxic medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132(88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations; GCS \u0026ndash;Glasgow coma score, UVA-Universal vital assessment score, MAP-Mean arterial pressure, HF-Congestive cardiac failure and WBC-White blood cells\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors for AKI among critically ill patients\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePatients were divided into two groups those with AKI and those without AKI. Nine potential variables were identified after performing univariable logistic regression analyses. Backward elimination reduced these to 8 parameters; Variables with higher odds for AKI after multivariable logistic regression analysis were: HF [OR 5.3, 95% CI (1.34\u0026ndash;21.1), \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.018], use of local herbs [OR 4.68, 95% CI (1.53\u0026ndash;14.33), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.007\u003c/em\u003e], malignancy [OR 4.5,95% CI (1.53-13.0), \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.006], obstetric complications [OR 3.69, 95% CI (1.25\u0026ndash;10.88), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.018\u003c/em\u003e], Severe UVA score [OR 2.57, 95% CI (1.30\u0026ndash;5.06), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.006\u003c/em\u003e], sepsis [OR 2.56, 95% CI (1.18\u0026ndash;5.55), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.018\u003c/em\u003e], anaemia [OR 1.96, 95% CI (1.12\u0026ndash;3.34), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.029\u003c/em\u003e] and rural residency [OR 1.99, 95% CI (1.14\u0026ndash;3.47), \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.016] (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRisk factors for AKI among critically ill patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber (n) (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eUnadjusted\u003c/p\u003e\n \u003cp\u003eOR [95% CI]P-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAdjusted\u003c/p\u003e\n \u003cp\u003eOR [95% CI] P-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63(42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87(58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.64(1.04\u0026ndash;2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.99(1.14\u0026ndash;3.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUVA Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild (0\u0026ndash;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4(1.324\u0026ndash;4.353)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.37(0.66\u0026ndash;2.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere (\u0026gt;\u0026thinsp;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92(61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.97(2.44\u0026ndash;10.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.57(1.30\u0026ndash;5.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanical ventilation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96(64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54(36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.17(1.27\u0026ndash;3.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.1(0.533\u0026ndash;2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9(1.69\u0026ndash;5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.56(1.18\u0026ndash;5.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e137(91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8(1.3\u0026ndash;17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.3 (1.34\u0026ndash;21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e133(88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.5(2.43\u0026ndash;17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.5(1.53-13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocal herbs use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e139(92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8(1.36\u0026ndash;10.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.68(1.53\u0026ndash;14.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstetric complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e136(90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3(1.29\u0026ndash;8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.69(1.25\u0026ndash;10.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72(48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78(52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4(1.528-3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.96(1.12\u0026ndash;3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNephrotoxic medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e132(88.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0(1.458\u0026ndash;11.174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.59(0.47\u0026ndash;5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e128(85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87(0.533\u0026ndash;1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.559\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.511(0.25\u0026ndash;1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79(52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71(47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8(0.54\u0026ndash;1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.0(0.51\u0026ndash;1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eOutcomes of AKI among patients admitted with critical illness\u003c/h3\u003e\n\u003cp\u003ePatients with AKI had longer mean hospital stay of 12 days as opposed to 8 days in non AKI cases (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the patients who had AKI, 29 (19.33%) had AKI resolution, 36(24%) developed AKD, 15 (10%) developed CKD and 70 (46.7%) died (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of all-cause mortality among critically ill patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter running univariable cox proportional hazard, 8 factors were found to be associated with mortality after 3 months follow up. They were then subjected into multivariable cox proportional hazard of which old age and AKI were found to be independent predictors of mortality among the study participants. Where for every unit increase in age there was 2.1 more likelihood of dying [HR 2.1, 95% CI (1.25\u0026ndash;3.5), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.005\u003c/em\u003e]. Also, patients with AKI were 1.8 more likely to die as compared to those with no AKI [HR 1.82, 95% (CI 1.16\u0026ndash;2.87), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.01\u003c/em\u003e] (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePredictors of All-cause Mortality among patients with AKI (cox proportional Hazard.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber (n) (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eUnadjusted\u003c/p\u003e\n \u003cp\u003eOR [95% CI] P-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAdjusted\u003c/p\u003e\n \u003cp\u003eOR [95% CI] P-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e) years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116(38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(40\u0026ndash;59) Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87(28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.074(1.23\u0026ndash;3.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.07(1.22\u0026ndash;3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(\u0026ge;\u0026thinsp;60) Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100(33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.28(1.38\u0026ndash;3.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.08(1.25\u0026ndash;3.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUVA SCORE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild (0\u0026ndash;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93(30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.807(0.423\u0026ndash;1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.79(0.412\u0026ndash;1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere (\u0026gt;\u0026thinsp;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144(47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.94(1.137\u0026ndash;3.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4(0.809\u0026ndash;2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanical ventilation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e217(71.6))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86(28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.538(1.03\u0026ndash;2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.998(0.632\u0026ndash;1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222(73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81(26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.581(0.389\u0026ndash;0.868)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.20(0.73\u0026ndash;1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e271(89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.22(1.35\u0026ndash;3.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4(0.827-2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNephrotoxic medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e280(92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.474(0.27\u0026ndash;0.834)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.17(0.60\u0026ndash;2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAKI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153(50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e150(49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.449(1.611\u0026ndash;3.723)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.82(1.16\u0026ndash;2.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePatients without AKI were found to have better survival as opposed to patients with AKI\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients with AKI were found to have higher mortality as opposed to patients with no AKI\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the incidence, factors associated with and outcomes of AKI among adult patients admitted with critical illness in tertiary hospitals in Dodoma. The incidence of AKI among adult patients admitted with critical illness in this study was 49.5%. Similar findings have been reported from previous studies where upto 50% of patients admitted with critical illness in intensive care units were found with AKI (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). This incidence is higher than the findings from previous studies that were conducted among critically ill patients in Uganda, Kingdom of Bahrain and Brazil where the incidence of AKI was 70 (95% CI 55\u0026ndash;90) per 1000 person days of observation, 17.9% and 21.3% respectively (\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Our study findings are lower when compared to a previous study that was conducted in Tanzania where the incidence of AKI among patients admitted in ICUs was 55.3% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Also, the incidence of AKI was reported to be \u0026gt;\u0026thinsp;50% in patients admitted in intensive care units worldwide including in developing countries ICUs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These differences could be accounted by geographical and population variations in the studies.\u003c/p\u003e \u003cp\u003ePatients admitted with severe illness are at increased risk of developing AKI. Most (61.3%) of the patients who had AKI in this study were admitted with severe UVA score and severe UVA score had 3-fold increased odds for AKI. Similar to findings from previous studies that reported majority of patients who developed AKI were found to be admitted in ICUs and were found to be severely ill (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Adult patients admitted with malignancy have a high incidence of AKI. Few (18.0%) of the patients who had AKI were found with malignancy and being found with malignancy had 5-fold increased odds for AKI. Similar to findings from previous studies; adult patients admitted with malignancy experienced a high incidence of AKI (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Acute kidney injury is a common complication in adult patients admitted with heart failure. In this study, few (8.7%) of the adult patients who had AKI were found with HF and HF had 5-fold increased odds for AKI. Similar to findings from previous studies that reported patients with HF who were admitted with critical ilness had increased risks for AKI (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePatients admitted with sepsis are at higher risk for sepsis-associated AKI. One third (33.3%) of the patients admitted with critical ilness in this study were found with sepsis and sepsis had 3-fold increased odds for AKI. Similar findings have been reported from previous studies where most of the patients admitted with critical illness due to sepsis had AKI (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Acute kidney injury is a common complication found in adult patients presenting with anemia and are critically ill. Most (52%) of the patients who had AKI presented with anaemia and anemia had 2-fold increased odds for AKI. Similar to findings from previous studies which did demonstrate anemia by itself especially in critical illness has higher chances of causing AKI(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Adult patients presenting with underlying obstetric complications are at increased risk for developing AKI. Almost one third (27%) of the patients who had AKI presented with obstetric complications and obstetric complications had 4-fold increased odds for AKI. Similar to findings from previous studies; Obstetric complications such as pre-eclampsia and hemorrhage are associated with AKI in critically ill pregnant and postpartum adult patients(\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLocal herbs and remedies are a significant cause of AKI particularly in developing countries like Tanzania. Few (11.3%) of the patients who had AKI had history of using local herbs and using local herbs had 5-fold increased odds for AKI. Similar to findings from previous studies; patients using local herbs had higher chances of developing AKI (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Rural residency is associated with inequities like lack of early diagnosis and prevention of AKI. Most (58.0%) of the patients who had AKI were living in rural areas and riral residency had 2-fold increased odds for AKI. Similar to findings from previous studies; inequities in access to optimal care and preventative strategies contribute to increased risk for developing AKI in rural areas (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAcute kidney injury in critically ill adult patients is associated with increased risks for AKD, CKD and death(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In this study almost half of the patient with AKI among those will critical illness died. Similar to findings from previous studies; AKI was strongly associated with increased mortality; with AKI doubling the risk of hospital deaths (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Acute kidney injury in patients admitted with critical illness results into prolonged hospital stays. In this study, patients with AKI had longer mean hospital stay when compared to those patients wihout AKI. Similar to findings from previous studies that demonstrated that the presence of AKI is associated with increased length of hospital stay (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Patients with AKI were 1.8 more likely to die as compared to those with no AKI. Similar to findings from previous; AKI is an independent predictor of mortality among critically ill patients (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). While advanced age tends to correlate with higher mortality rates; for every unit increase in age there was 2.1 more likelihood of dying. Similar to findings from previous which did demonstrate that AKI is a frequent complication in elderly critically-ill patients (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe limitations of this study include: this study was conducted in two tertiary hospitals in Dodoma, Tanzania thus restricting its generalizability. Despite these limitations, this prospective observational study provides data on the incidence, factors associated with and outcomes of AKI among adult patients admitted with critical illness in tertiary hospitals in Dodoma.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe incidence of AKI and its associated mortality is high among adult patients admitted with critical illness in our settings. Use of local herbs, Congestive Cardiac Failure, severity of illness, malignancys, obstetric complications and sepsi were found to be strongly associated with AKI. Patients with AKI had longer mean hospital stays, few patients developed CKD and almost half of the patients with AKI died. This is a call for clinicians to prioritize and identify patients admitted with critical illness who are more likely to develop AKI and monitor them closely to minimize chances for them dying and progressing to CKD.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAKI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eacute kidney injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eadjusted odd ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBenjamin Mkapa Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echronic kidney diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCKD-EPI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echronic kidney disease epidemiology collaboration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecardiovascular diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ediastolic blood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDRRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDodoma Regional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eeGFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eestimated glomerular filtration rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESRD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eend stage renal disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehuman immunodeficiency virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIDMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eisotope dilution mass spectroscopy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKDIGO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ekidney disease improving global outcomes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow and Middle-Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNCDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003enon-communicable diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erenal replacement therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esystolic blood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUDOM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of Dodoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUGIB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eupper gastrointestinal bleeding\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSub-Saharan Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ewhite blood cell count\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e Ethical approval was obtained from the University of Dodoma research and ethics committee (reference number MA.84/261/ 02/A/65/28). Written informed consent was obtained from each of the participant before recruitment of study participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot required\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study received no specific funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTJD; participated in original design of the study, collection of data, data analysis and manuscript writing; ES: participated in design of the study, data collection, data analysis and manuscript writing; AM: participated design of the study, data collection, data analysis and manuscript writing. All authors have read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eSpecial thanks to members of staff at the BMH and DRRH for their assistance in making this study possible. Additional thanks to the members of the Department of Internal Medicine of the School of Medicine, The University of Dodoma for their technical assistance. In a special way, we thank all the patients who were critically ill and were admitted in ICUs of Both Benjamin Mkapa Hospital and Dodoma Regional Referral Hospitals who agreed to participate in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData cannot be shared publicly because of ethics policy of the University of Dodoma. Data are available to researchers who meet the relevant ethics criteria from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOstermann M, Lumlertgul N, Jeong R, See E, Joannidis M, James M. Acute kidney injury. The Lancet. 2025;405(10474):241\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBikbov B, Fortino I, Leoni O, Nobili A, Tettamanti M. Burden of Acute Kidney Injury among Adult Hospital Patients in the Italian Lombardy Region: A 20-Year Real-World Data Analysis. Nephron. 2023;147(10):599\u0026ndash;607.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsposito P, Cappadona F, Prenna S, Marengo M, Fiorentino M, Fabbrini P, et al. Acute kidney injury in hospitalized patients with real-life analysis of incidence and clinical impact in Italian hospitals (the SIN-AKI study). Scientific Reports. 2025;15(1):14261.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelo FAF, Burdmann EA, Macedo E, Mehta R, Zanetta DMT. Acute kidney injury developed in the intensive care unit: a population-based prospective cohort study in the Brazilian Amazon. Sci Rep. 2024;14(1):22954.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBien Z, Fowler AJ, Robbins AJ, Pearse RM, Prowle JR, Wan YI. Trends in Hospital Admissions Associated with an Acute Kidney Injury in England 1998\u0026ndash;2020: a Repeated Cross-Sectional Study. SN Comprehensive Clinical Medicine. 2022;4(1):53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRewa OG, Ortiz-Soriano V, Lambert J, Kabir S, Heung M, House AA, et al. Epidemiology and Outcomes of AKI Treated With\u0026nbsp;Continuous Kidney Replacement Therapy: The\u0026nbsp;Multicenter CRRTnet Study. Kidney Medicine. 2023;5(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndonovic M, Traynor JP, Shaw M, Sim MAB, Mark PB, Puxty KA. Short- and long-term outcomes of intensive care patients with acute kidney disease. eClinicalMedicine. 2022;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGameiro J, Marques F, Lopes JA. Long-term consequences of acute kidney injury: a narrative review. Clinical kidney journal. 2021;14(3):789\u0026ndash;804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmazmomi MA, Esmat A, Naeem A. Acute Kidney Injury: Definition, Management, and Promising Therapeutic Target. Cureus. 2023;15(12):e51228.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeyra JA, Ortiz-Soriano V, Liu LJ, Smith TD, Li X, Xie D, et al. Prediction of Mortality and Major Adverse Kidney Events in Critically Ill Patients With Acute Kidney Injury. 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Renal failure. 2025;47(1):2591255.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Incidence, Factors associeted, Outcomes, Acute kidney injury, Critical illness","lastPublishedDoi":"10.21203/rs.3.rs-8779910/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8779910/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of acute kidney injury (AKI) is highest in low and middle income countries despite the International Society of Nephrology (ISN) 0 by 2025 initiative. Critically ill patients are at increased risk for developing AKI, chronic kidney disease (CKD), end stage renal disease and death.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eA prospective observational study was conducted among critically ill patients attending tertiary hospitals in Dodoma between October 2023 and May 2024. At baseline, patients’ demographic and clinical data were collected and laboratory investigations were performed to evaluate AKI. Patients were evaluated for AKI using the KDIGO criteria at baseline, 48 hours, on the 7th day and eGFR was calculated after 3 months using CKD-EPI equation. Atatistical analyses were conducted with SPSS (version 27). Logistic regression analyses were used to identify factors associated with AKI among critically ill patients and cox proportional hazard was used to determine predictors of mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 303 critically ill patients were enrolled into the study with a median age of 45 (IQR 32–65) years and 54.8% were male. On admission; the median serum creatinine was 101(89–155)µmol/L and the median haemoglobin was 13(9–14) g/dl. The incidence of AKI among critically ill patients was 49.5% (150/303). Factors associated with AKI included; HFheart failure [OR 5.3, 95% CI (1.34–21.1), P \u003cem\u003e=\u003c/em\u003e 0.018], use of local herbs [OR 4.7, 95% CI (1.53–14.33), P = 0.007], malignancy [OR 4.5, 95% CI (1.53-13.0), P = 0.006], obstetric complications [OR 3.69, 95% CI (1.25–10.88), P \u003cem\u003e= 0.018\u003c/em\u003e], illness severity [OR 2.57, 95% (CI 1.30–5.06), P \u003cem\u003e= 0.006\u003c/em\u003e] and sepsis [OR 2.56, 95% (CI 1.18–5.55) P \u003cem\u003e= 0.018\u003c/em\u003e]. Patients with AKI had longer mean hospital stays as compared to those without AKI(p \u0026lt; 0.01), 10% (15/150) developed CKD and 46.7% (70/150) died. Predictors of mortality were age [HR 2.1, 95% CI (1.25–3.5), \u003cem\u003ep = 0.005\u003c/em\u003e] and AKI [HR 1.82, 95% (CI 1.16–2.87), \u003cem\u003ep = 0.01\u003c/em\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of AKI and its associated mortality is high among adult patients admitted with critical illness in our settings. Use of local herbs, heart failure, severity of illness,malignancy, obstetric complications and sepsis were found to be strongly associated with AKI. Patients with AKI had longer mean hospital stays and almost half of the patients AKI died during hospitalization.\u003c/p\u003e","manuscriptTitle":"Acute kidney injury among adult patients admitted with critical illness in tertiary hospitals in Dodoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 16:47:47","doi":"10.21203/rs.3.rs-8779910/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"04ae2da2-ef38-4b6c-8b3f-de89711e1e2d","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-03T12:09:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 16:47:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8779910","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8779910","identity":"rs-8779910","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}