Reducing mortality in acute kidney disease through comprehensive laboratory support: Findings from the ICLATA hybrid implementation study in Zambia

Acute kidney disease (AKD) contributes significantly to morbidity and mortality, particularly in low-resource settings where limited diagnostic capacity often leads to delayed recognition and suboptimal management. We aimed to evaluate the impact of implementing a comprehensive patient-specific clinical laboratory support on clinical outcomes in AKD and to identify factors associated with mortality. We conducted a mixed-method hybrid type 3 implementation study at Livingstone University Teaching Hospital in Zambia. The study compared a retrospective non-intervention cohort (NIC; n = 39) with a prospective intervention cohort (IC; n = 39) matched for age and sex. The intervention included providing full laboratory diagnostic support for AKD management and additional patient-specific tests. The primary outcome was death within 30 days after admission regardless of whether the patient was discharged before or after the thirty-day period elapsed. Data were analyzed using logistic regression and survival analysis. The median age of the NIC (43 years, IQR 31-53) was comparable to the IC (41 years, IQR 34-53), p = 0.996. Overall, 51.3% (n = 40/78) were males. Mortality rate was significantly lower in the intervention group, with deaths occurring in 5.1% of the IC compared to 28.2% in the NIC (p = 0.012). Logistic regression confirmed the intervention as a strong independent predictor of survival (adjusted odds ratio 0.07, p = 0.009). Diagnostic accuracy improved, with fewer cases of misdiagnosis or delayed diagnosis in the IC (7.7% vs 30.8%, p = 0.019). Re-hospitalization was significantly lower in the IC (38.6% vs 61.4%, p = 0.022). ESRD was more frequently recorded in the IC due to better diagnostics, follow-up and survival. The median time-to-ESRD was substantially longer in the IC compared to NIC (140 vs 21 days, p < 0.0001). Implementation of a comprehensive patient-specific clinical laboratory support for AKD/CKD management significantly improved diagnostic precision and survival and reduced re-hospitalization. These findings highlight the value of strengthening laboratory diagnostic capacity to improve AKD outcomes in low-resource settings.