Angèle Masewu1, Jean-Robert Makulo2* , François Lepira2, Eric Bibonge Amisi1, Ernest Kiswaya Sumaili2,
Justine Bukabau2,5, Vieux Mokoli2, Augustin Longo2, Yannick Nlandu2, Yannick Engole2, Cedric Ilunga2,
Alphonse Mosolo1,3, Alex Ngalala4,5, Justin Kazadi6, Richard Mvuala7, Jackson Athombo8, Nkodila Aliocha2,
Pierre Zalagile Akilimali9, Adolphe Kilembe1,7, Nazaire Nseka2 and Michel Jadoul10

Abstract
Background: Despite the growing incidence of acute kidney injury (AKI) worldwide, there is little data on the burden and outcomes of AKI in intensive care unit (ICU) in low resource settings. The present study assessed the incidence of AKI and its impact on mortality in ICU in Kinshasa (Democratic Republic of Congo).
Methods: In a prospective cohort study, 476 consecutive critically ill patients (mean age 52 years, 57 % male) were screened for the presence of AKI in seven ICU from January 1st to March 30th, 2015. Serum creatinine was measured by the enzymatic method (Cobas C111 device®). AKI and its stages (no AKI, AKI 1, AKI 2 and AKI 3) were defined according to AKIN recommendations. The primary outcome was 28 days mortality. Survival (time-to death) curves were built using the Kaplan Meier methods. Predictors of mortality were assessed by Cox proportional hazards regression models. p < 0.05 defined the level of statistical significance.
Results: The cumulative incidence of AKI was 52.7 % with AKI stage 1, 2 and 3 in 23.7 %, 16.2 % and 12.8 % of patients, respectively. Among patients who developed AKI, 146 died (58 %) vs 62 patients (28 %) in the group without AKI. Only 6.5 % of the patients with AKI stage 3 benefited from dialysis. Median survival time was 15.0 days in patients without AKI and 3.0 days, 6.0 days and 8.0 days in patients with AKI stage 3, 2 and 1 (p < 0.001), respectively. In addition to respiratory distress-induced polypnea (HRa 1.60; 95 % CI: 1.08–2.37; p = 0.018), oxygen desaturation (HRa 1.53; 95 % CI: 1.13–2.08; p = 0.006) and multi-organic involvement (HRa 1.63; 95 % CI: 1.15–2.30), AKI emerged as an independent predictor of death (HRa 1.82; 95 % CI: 1.34–2.48; p < 0.001). Conclusion: More than half of critically ill patients in the present cohort developed AKI which contributed
substantially to short-term mortality, highlighting the need for its prevention, early detection and management as well as the availability of dialysis in ICU.
Keywords: Acute kidney injury, Intensive care unit, Incidence, Mortality, Black Africans (Continued on next page)

Masewu et al. BMC Nephrology (2016) 17:118
DOI 10.1186/s12882-016-0333-4