Predictors of renal non-recovery among hospitalized patients with acute kidney injury in Ethiopia: A prospective observational study

Little is known about renal recovery after acute kidney injury (AKI), particularly in countries with limited resources. This study aimed to explore the patterns of renal recovery and predictors of renal non-recovery among hospitalized patients with AKI in Ethiopia. A prospective observational study was conducted involving all adult patients aged ≥18 years, who met the kidney disease: improving global outcomes criteria for AKI from April to July 2019. The main outcome variable was renal recovery, defined as reversal at discharge or return to baseline kidney function. Reversal from an AKI episode was defined as no longer meeting AKI criteria. Non-recovery was defined as AKI that did not return to baseline kidney function at hospital discharge. A logistic regression model was used to determine the predictors of non-recovery AKI. Statistical significance was considered at a P-value of <.05 on multivariate analysis. Of the 169 patients included in the study over 4 months, one-third (33.1%) had stage 3 AKI, nearly half (50.29%) had pre AKI, and 32 (19%) had exposure to nephrotoxic drugs. Of these, 115 (68%) had complete renal recovery, and 54 (32%) had non-recovery AKI. In patients with complete recovery, 17 (10%) had early sustained reversal, 78 (46%) had late sustained reversal, and the remaining 20 (12%) had relapsing AKI with complete recovery. Among patients with non-recovery AKI, 23 (13.6%) had relapsing AKI without recovery, and 31 (18.4%) did not recover during their hospital stay. A higher rate of non-recovery was observed in patients with severe AKI. Stage III AKI (adjusted odds ratio: 4.7, confidence interval: 1.37-28.6, P = .019) and nephrotoxic drug use (adjusted odds ratio: 5.2, confidence interval: 2.1-14.89, P = .007) were significantly associated with renal non-recovery. The study found that around two-thirds of the patients had complete renal recovery and nearly one-third had non-recovery AKI at hospital discharge. Renal non-recovery was significantly associated with the severity of AKI and the use of nephrotoxic drugs. Close monitoring of serum creatinine levels and careful drug use monitoring may help identify patients with poor prognosis, initiate specific interventions, and improve renal recovery.