The Clinical and Comorbidity Profile of Acute Kidney Injury in Critically Ill Patients: A Multi-Center Cross-Sectional Study from Sudan

Abstract

Background: The demographic and etiological landscape of Acute Kidney Injury (AKI) varies significantly across regions, influenced by local disease burdens and healthcare access. Data on AKI characteristics from Sudan and similar sub-Saharan African settings are scarce. This study describes the clinical presentation, age distribution, and comorbidity profile of critically ill patients with AKI in Sudan. Methods: A prospective, multi-center, cross sectional study was conducted in four major Sudanese hospitals between July and September 2022. All consecutively admitted adult ICU patients meeting KDIGO criteria for AKI were enrolled. Data on demographics and comorbidities were collected using a structured checklist. Descriptive statistics were used for analysis. Results: Forty-two patients were included. The cohort was notably young age distribution, with 41.5% aged 18-39 years. A significant gender-age interaction was noted: younger patients were predominantly female (80%), while elderly patients (≥60 years) were predominantly male (71%). The comorbidity burden was substantial, with 83.4% of patients having at least one chronic condition, a mean of 1.9 comorbidities per patient, and hypertension (43.9%) and diabetes mellitus (34.1%) being most prevalent. The overall 30-day mortality rate was 29.3%, demonstrating a clear age-dependent gradient. Comorbidity burden was a critical prognostic factor; mortality was 62.5% in patients with ≥3 comorbidities versus 14.3% in those with none. Specific combinations, particularly diabetes + hypertension + cerebrovascular disease, were associated with extremely high mortality (75%). Among survivors, 74.2% recovered normal renal function, while 25.8% progressed to chronic kidney disease. Conclusion: This study reveals that AKI in this setting is strongly linked to a high burden of non-communicable diseases, leading to significant mortality. The young age of the cohort and the unique gender-age interaction suggest distinct, age-specific risk pathways. The catastrophic outcomes associated with multiple comorbidities, especially the cardio-metabolic triad, identify a high-risk subgroup requiring intensive management. The study underscores the urgent need for integrated chronic disease management to prevent AKI and for vigilant recognition of high-risk profiles to improve outcomes.