Background: Acute Kidney Injury (AKI) is a major problem worldwide as it is associated with high morbidity and mortality. The picture is likely to be worse in the geriatric population of developing countries due to associated comorbid conditions. This study describes the prevalence, associated factors and clinical outcomes of Acute Kidney Injury among elderly patients admitted at Princess Marina Hospital (PMH), Gaborone, Botswana. Methods: A retrospective cross-sectional study involved elderly patients admitted to the medical wards of Princess Marina Hospital in Gaborone, Botswana from 1st March 2017 to 28th February 2018. The medical charts of participants admitted in the study period were screened to identify and include all the participants meeting the inclusion criteria. Frequencies were used to describe demographic, clinical characteristics and outcomes of study participants. Bivariate and multivariate logistic regression analysis was used to evaluate the factors associated with AKI. A p-value of < 0.05 was considered statistically significant. Results: Almost a third, 261/871 (29.96%) of admitted elderly patients had AKI. Final analysis involved 613 retrieved records (242 records of AKI and 371 records without AKI). The mean age of participants was 66.98 (11.86) years. The male gender comprised 58.1% of the participants. The factors independently associated with AKI were hypertension, heart and liver failure, sepsis, use of nephrotoxic drugs, polypharmacy and hypotension. About a fifth of patients, 50/242 (20.7%) with AKI, either recovered to normal or baseline serum creatinine before discharge. Over a third of participants did not recover to normal/ baseline serum creatinine at discharge; they comprised 96/242 (39.7%). Similarly, over a third of elderly patients with AKI, 96/242 (39.7%) died. Serum potassium was significantly associated with AKI non-recovery to normal or baseline serum creatinine. Age over 80 years, chronic lung disease, heart failure and higher creatinine level at AKI diagnosis were independently associated with high all-cause mortality. Conclusions: The prevalence of AKI among elderly patients admitted to medical wards of a referral hospital in Botswana is high and AKI is associated with a high all-cause mortality. The commonest risk factors independently associated with AKI among elderly participants were hypertension, heart failure, liver failure, sepsis, polypharmacy, use of nephrotoxic drugs and hypotension. Serum potassium was significantly associated with AKI non-recovery. The old age of more than 80 years old, chronic lung disease and worse serum creatinine at AKI diagnosis were associated with mortality whereas having heart failure conferred a better chance of survival. There is a need to conduct a prospective multicenter observational study in Botswana to obtain findings that will help generalizability while at the same time establishing long-term outcomes of patients discharged with impaired renal functions.
