Acute Kidney Injury and Trauma Patients Under the Spotlight
“The Incidence and Outcomes of Acute Kidney Injury Amongst Patients Admitted to a Level I Trauma unit”, was the title of a thesis which earned Dr David Skinner, a UKZN Clinical Medicine graduate, a Masters of Medicine degree in Surgery.
This project was published as a paper in 2014 in Injury, Int. J. Care Injured 45 (2014) 259–264 Skinner’s study, supervised by Dr T Hardcastle, Professor DJJ Muckart and Dr RN Rodseth; involved the analysis of all patients presenting to the Trauma Intensive Care Unit (ICU) at Inkosi Albert Luthuli Central Hospital and identifying the presence of renal dysfunction - the current modern terminology being acute kidney injury (AKI) - and attempted to identify risk factors for this condition.
Skinner performed a retrospective observational study of 666 patients admitted to the Trauma ICU from March 2008 to March 2011 and conducted multivariable logistic regression to identify independent predictors for AKI and mortality. ‘We looked at the patient’s outcomes in terms of mortality and the utilisation of renal replacement therapy (dialysis). A small subset of patients who had developed renal failure as a result of sjambok injuries was also analysed,’ said Skinner.
He explains that ‘patients with sjambok injuries have severe renal dysfunction but seem to have better outcomes in terms of mortality relation to other patients with similar levels of renal dysfunction’.
The renal dysfunction resulting from injury with a sjambok is a uniquely South African problem. Because of this, it has led Skinner to develop more research questions directed around trauma related acute kidney injury within the South African context.
Renal replacement therapy, in the form of haemodialysis, is a precious resource in South Africa and further work is needed for decisions on rational distribution of this resource in critically ill surgical and trauma patients. It was found that ‘AKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low base excess. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden’.
Skinner is a specialist surgeon and is currently working as a consultant at King Edward VIII Hospital in the Intensive Care Unit. He is also in the process of conducting further research on renal dysfunction in surgical and trauma patients and has completed a paper recently examining blunt cardiac injuries in patients who sustained blunt thoracic trauma.
- Zakia Jeewa