Nephrology consultation patterns and clinical outcomes in an Egyptian tertiary healthcare center: a retrospective analysis from a lower-middle-income country perspective

Abstract

Understanding kidney disease outcomes is crucial for optimizing treatment. In developing nations, the rising noncommunicable disease burden strains hospital services, highlighting the critical need to evaluate inpatient nephrology consultation patterns and patient outcomes. This single-center retrospective cohort analysis evaluated all adult patients referred for inpatient nephrology consultation at Alexandria Main University Hospital between July and December 2022. Primary objectives were to determine the primary causes of consultations and evaluate adverse clinical outcomes, specifically in-hospital mortality and the need for renal replacement therapy (RRT). Secondary objectives included assessing rates of ICU transfer and hospital-acquired infections (HAIs). Over 6 months, 1,198 (1.65%) of 72,505 total hospital admissions required a nephrology consultation. Final diagnoses included: AKI (38.9%), AKI superimposed on CKD (28.6%), and ESKD (22.7%). Hemodialysis was required by 39.2% of the cohort. Overall mortality was 20.9%; the AKI group demonstrated significantly higher mortality (29.6%) compared to CKD/ESKD groups (p < 0.001). Multivariate regression showed that initial ICU admission (OR 37.89, 95% CI 6.35–226.01), subsequent ICU transfer (OR 18.75, 95% CI 9.88–35.58), the presence of HAI (OR 2.57, 95% CI 1.58–4.19), hypoalbuminemia (OR 0.33, 95% CI 0.21–0.52), and lower serum creatinine (OR 0.93, 95% CI 0.88–0.98) were independently associated with mortality. Nephrology consultations are vital; renal impairment is heavily associated with prolonged hospitalization, ICU admission, and mortality. Across all cohorts, hypoalbuminemia and ICU admission consistently predicted mortality.