Electrolytes and Mortality in Critically Ill Patients with Acute Kidney Injury: A Prospective Multi-Center Study from Sudan

Acute kidney injury (AKI) carries a high mortality risk, especially in resource-limited settings. Electrolyte imbalances are common in AKI, but their prognostic value in sub-Saharan African populations is understudied. This study evaluated the prevalence of admission serum sodium (Na+) and potassium (K+) abnormalities and their association with 30-day mortality in critically ill AKI patients in Sudan. A prospective, multi-center, cross-sectional study was conducted across four Sudanese hospitals from July to September 2022. Forty-two critically ill adult patients with AKI were enrolled. Demographic, clinical, and biochemical data were collected. The primary outcome was 30-day all-cause mortality. Data were analyzed using SPSS version 25 with descriptive statistics, chi-square tests, and mortality outcome assessments. The mean age of participants was relatively young, with 42.9% aged 18–39 years. Male gender predominated (61.9%). The most common comorbidities were hypertension (69.0%), diabetes mellitus (42.9%), and chronic liver disease (76.2%). Serum sodium levels ranged from 89 to 156 mmol/L, and potassium levels ranged from 2.3 to 11.0 mmol/L. The 30-day mortality rate was 57.1%. Patients with hyperkalemia (K+ ≥ 5.5 mmol/L) and dysnatremia (Na+ <130 or >145 mmol/L) had significantly higher mortality rates (p < 0.05). Admission serum sodium and potassium levels are prevalent, low-cost prognostic markers in critically ill AKI patients. Severe hyperkalemia and dysnatremia were strongly associated with increased 30-day mortality. Early identification and management of these imbalances could improve survival outcomes, particularly in ICU settings with limited resources.