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Submitted: May 07, 2026 | Accepted: May 13, 2026 | Published: May 14, 2026

Citation: Sabi AK, Blatome LO, Dolaama B, Tsevi YM, Amede AD, Haroune-Traore J, et al. Acute Kidney Injury and Ad Hoc Consultancy Opinions of Nephrology Consultants in the Ivory Coast: Epidemiological, Diagnostic, and Prognostic Aspects. J Clini Nephrol. 2026; 10(5): 44-49. Available from:
https://dx.doi.org/10.29328/journal.jcn.1001175

DOI: 10.29328/journal.jcn.1001175

Copyright license: © 2026 Sabi AK, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: Acute kidney injury; Expert opinion

Acute Kidney Injury and Ad Hoc Consultancy Opinions of Nephrology Consultants in the Ivory Coast: Epidemiological, Diagnostic, and Prognostic Aspects

Akomola Kossi Sabi1, Laune Odilon Blatome2,3*, Badomta Dolaama1, Yawovi Mawufemo Tsevi1, Amah Daniel Amede4, Jannat Haroune-Traore4, Eyram Yoan Makafui Amekoudi2, Monlet Cyr Guei3, Delphine Amélie Lagou3 and Kan Clément Ackoundou-N’guessan3

1Nephrology and Hemodialysis Department, Sylvanus Olympio University Hospital of Lomé, Togo
2Nephrology Department, Kara University Hospital, Togo
3Nephrology Department, Yopougon University Hospital; Félix Houphouët-Boigny University, Ivory Coast
4Nephrology-Internal Medicine D Department, Treicheville University Hospital; Department of Medicine and Medical Specialties, UFR of Medical Sciences, Félix Houphouët-Boigny University, Ivory Coast

*Corresponding author: Laune Odilon Blatome, Nephrology Department, Kara University Hospital, TOGO, Email: [email protected]

Summary
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Context: Acute kidney injury is a serious and frequently encountered condition in hospital settings, with an increasing incidence. Given the increasing number of evidence reporting the benefits of specialized and early nephrology care, the Ad Hoc Consultancy Opinion regains a crucial interest in the nephrology care pathway. In the Ivory Coast, data concerning this activity are rare. The objective of this study was therefore to evaluate the Ad Hoc Consultancy Opinion impacts under our practice conditions.

Methods: Our study will focus on all patients of the CHU Treicheville without a history of kidney disease seen in the Ad Hoc Consultancy Opinion by the nephrology team of said center over the period from October 1, 2022, to March 31, 2023.

Results: The consultative nephrology service involved 106 patients with an average age of 45.1 +/- 21.1 years. The average delay for requesting the consultation was 2.6 +/- 2.5 days. Acute kidney injury was at stage 3 of the KDIGO classification in 73.6% (n = 78). Emergency hemodialysis accounted for 59.4% of the indications. The mortality was 22.6%, and the risk of death was associated with coma (p = 0.014), left heart failure (p = 0.009), ARDS (p = 0.035), the severity of AKI (p = 0.024), and the Ad Hoc Consultancy Opinion delay > 3 days (p = 0.010).

Conclusion: Our study adds weight to the claims that early specialized management of kidney disease affects the nephrological outcome and survival of patients.

Introduction
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Acute kidney injury (AKI) is a serious and frequently encountered condition in hospital settings, with an increasing incidence [1]. It is responsible for significant morbidity and mortality, including a four-fold increase in the risk of in-hospital mortality [1,2]. Given the growing evidence reporting the benefits of specialized and early nephrology care particularly regarding the slowing of disease progression, the reduction of hospitalization duration, and decreased mortality the Kidney Disease Improving Global Outcomes (KDIGO) organization established reference criteria for nephrology practice in 2012 [3-7]. As the health workforce represents the cornerstone of any healthcare system, the Ad Hoc Consultancy Opinion (AHCO) holds paramount importance within the nephrology care pathway, as it serves to fulfill a key objective: optimizing access to care. In the Ivory Coast, however, data on this activity remain scarce or altogether absent. The aim of this study was therefore to provide insights into AKI among patients evaluated through AHCO. The working hypothesis is that early management of kidney diseases improves patient survival and their renal prognosis.

Methods
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Patients

We conducted an analytical cross-sectional study with prospective data collection on a consecutive cohort of patients treated for AKI between October 1, 2022 and March 31, 2023 at the Treichville University Hospital Center (CHU).

Methods

This was an exhaustive sampling, including patients without a history of kidney disease seen in AHCO and followed for AKI over the duration of hospitalization by the nephrology team of the said center. Data were collected using a standardized electronic form deployed on the KoBoToolbox platform, alongside the clinical hospitalization records. The database was cleaned and analyzed using R software (version 4.3.1).

The parameters studied included socio-demographic, anamnestic, diagnostic, therapeutic, and evolutionary data. Qualitative variables were presented according to their frequencies and proportions, and quantitative variables according to their means, standard deviations, medians, and interquartile ranges. For the comparison of proportions, the Chi-square and Fisher’s exact tests were used according to their validity conditions. To compare means and medians, normality of distribution was first assessed using the Shapiro-Wilk test, after which nonparametric tests (Kruskal-Wallis and Mann-Whitney) were applied. The significance threshold was set at p < 0.05.

Operational definition
  • The Ad Hoc Consultancy Opinion is defined as an opinion provided by a specialist physician (referred to as the corresponding physician) at the explicit request of the attending physician.
  • AKI was defined and classified according to KDIGO recommendations, based on serum creatinine values determined during the inpatient stay [8].
  • AKI is considered functional in the presence of a renal hypoperfusion factor (diarrhea, vomiting, low cardiac output) or in the presence of signs of extracellular dehydration. It is considered obstructive in the presence of AKI associated with bilateral dilation of the pyelocaliceal cavities on ultrasound. [8]
  • The kidney biopsy having not been performed; acute tubular necrosis was suspected in the presence of AKI associated with proteinuria of less than 1g/24 hours, with or without oliguria. Acute glomerulonephritis (AGN) was retained in the presence of edema, arterial hypertension, positive albuminuria, and a decrease in the C3 fraction of complement. Acute interstitial nephritis was suspected in the presence of AKI with positive leukocyturia and preserved diuresis (1 to 2 liters per day), or in the presence of AKI with retained diuresis in the context of proven drug intake. Vascular nephropathy was retained in the presence of severe hypertension, proteinuria of less than 1g/24 hours, and the absence of edema in the lower limbs [8].
  • Oliguria was defined as a diuresis of less than 500 mL/24 hours. [8]
  • Anemia was defined as a hemoglobin level below 12 g/dL, and was considered severe when below 8 g/dL. [9].
  • Dialysis urgency was defined by the presence of any of the following: uremic encephalopathy, diuretic-resistant acute pulmonary edema (APE), threatening hyperkalemia, metabolic acidosis, severe uremia, or anuria lasting more than 24 hours. [10].
  • Severe uremia was defined by a serum urea level ≥ 2g/L with clinical signs of intolerance, including tremors of the extremities, hiccups, nausea, vomiting, somnolence, or coma [10].
  • Sepsis was diagnosed in accordance with the consensus guidelines of the American College of Chest Physicians and the Society of Critical Care Medicine [11].
  • Complete recovery was defined as a serum creatinine level below 15 mg/L at discharge and/or after 3 months of follow-up.
  • Partial recovery was defined as a decrease in serum creatinine with a lower KDIGO stage, without reaching a creatinine level below 15 mg/L after 3 months of follow-up.
  • Clinical evolution was considered favorable when partial or complete recovery was documented.
  • Clinical evolution was considered unfavorable when stagnation or an increase in serum creatinine was documented, with progression to a higher KDIGO stage.
    • Results
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    Epidemiological data

    During the study period, the nephrology department received 106 consultation requests for acute kidney injury, including 54 men, with a sex ratio of 1.04. The mean age of the patients was 45.1 ± 21.1 years, with a range of 2 to 82 years. The most affected age group was 45–54 years (24.5%) (Figure 1).


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    Figure 1: Distribution of patients by age group in years

    The mean time to AHCO after identification of nephrological abnormalities or symptoms was 2.6 ± 2.5 days. The departments that most frequently requested nephrology consultations were infectious diseases (24.5%) and medical emergencies (20.8%) (Figure 2).


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    Figure 2: Distribution of patients by inpatient department.

    Clinical and paraclinical data

    The reason for consultation request was renal function impairment in 100% of cases. Regarding medical history, there were 23 cases of arterial hypertension (21.7%), 18 cases of diabetes mellitus (17.0%), 15 cases of human immunodeficiency virus (HIV) infection (14.2%), and one case of scleroderma (0.9%). The main findings on clinical examination were conjunctival pallor (69.8%), fever (58.5%), and oligoanuria (53.8%).

    On biological assessment, anemia was present in 86.8% (n=92) of cases, with a mean hemoglobin level of 8.6 ± 2.7 g/dL (range: 3.0 to 13.8 g/dL). The mean serum creatinine was 98 ± 88.2 mg/L (range: 16 to 438 mg/L) and the mean serum urea was 1.8 ± 1.1 g/L (range: 0.5 to 4.9 g/L). Blood ionogram analysis revealed 83 cases of hyponatremia and 33 cases of hyperkalemia. The infectious workup identified 37 cases of malaria, 5 cases of urinary tract infection, and 5 cases of amicrobial leukocyturia out of 13 urine cytobacteriological examination (UCBE) samples performed, as well as 4 cases of streptococcal infection (ASLO positive) out of 8 samples tested.

    Diagnostic and prognostic data

    AKI was at stage 3 of the KDIGO classification in 73.6% of cases (n = 78). Based on the clinical circumstances and the pathophysiological factors identified, renal involvement was parenchymal in 67.0% of cases (Table 1). Regarding toxic or drug-related causes, polypharmacy (combination of antimalarial agents and ciprofloxacin) was identified in one case, and phytotherapy in 3 cases.

    Table 1: Summary of the lesional and etiological diagnosis
    Lesion diagnosis Etiological diagnosis Workforce Percentage
    Pre-renal   20 18,9%
      DEC 11 10,5%
      Low cardiac output 08 07,5%
      Hemorrhagic fibroid 01 00,9%
    Parenchymal   71 67,0%
    ATN   57 53,7%
      Sepsis 52 49,0%
      Toxic 04 03,8%
      Hemorrhagic 01 00,9%
    AGN   05 04,7%
      Post Streptococcal 04 03,8%
      Undetermined 01 00,9%
    AVN   05 04,7%
      Pregnancy 03 02,9%
      CRS 01 00,9%
      MNAS 01 00,9%
    AIN   04 03,8%
      Infectious pyelonephritis 02 01,9%
      Sepsis 02 01,9%
    Postpenal   15 14,2%
      Enlarged prostate 10 09,5%
      Urolithiasis 02 01,9%
      Uterine tumor 02 01,9%
      Bladder tumor 01 00,9%
    DEC: Extracellular Dehydration; CRS: Scleroderma Renal Crisis; ATN: Acute Tubular Necrosis; AGN: Acute Glomerulonephritis;
    AIN: Acute Interstitial Nephritis; AVN: Acute Vasculitis Nephropathy; MNAS: Malignant Nephroangiosclerosis.

    Emergency dialysis was indicated in 32 patients and initiated in 19, representing 59.4% of indications. The indications for emergency dialysis were uremic encephalopathy (22.6%), severe uremia (17.9%), and anuria lasting more than 48 hours (17.0%), hyperkalemia (4.7%), and acute pulmonary edema (APE) (4.7%).

    Clinical evolution was favorable in 52.8% of cases, with complete recovery in 28.3% and partial recovery in 24.5%. The dialysis weaning rate was 63.2% among dialyzed patients (n = 12), and mortality was 22.6% during the study period. The risk of death was significantly associated with coma (p = 0.014), left heart failure (p = 0.009), acute respiratory distress syndrome (ARDS) (p = 0.035), severity of AKI (p = 0.024), and delay in seeking nephrology consultation (p = 0.010) (Table 2).

    Table 2: Factors associated with the risk of death
    Variables N Deceased, n (%) Alive, n (%) p - value
    Socio-demographics        
    Gender 106     0,6
    Female   13 (54,2%) 39 (47,6%)  
    Male   11 (45,8%) 43 (52,4%)  
    Age 106     0,8
    < 60 years   16 (66,7%) 57 (69,5%)  
    ≥ 60 years old   08 (33,3%) 25 (30,5%)  
    Comorbidities        
    Diabetes 106 04 (16,7%) 14 (17,1%) > 0,9
    HIV 53 06 (46,2%) 09 (22,5%) 0,2
    Clinical        
    Fever 106 14 (58,3%) 55 (67,1%) 0,4
    Coma 106 14 (58,3%) 23 (28,0%) 0,014
    Oligo-anurie 106 11 (45,8%) 46 (56,1%) 0,4
    Left heart failure 106 04 (16,7%) 01 (01,2%) 0,009
    Right heart failure 106 00 (00,0%) 02 (02,4%) > 0,9
    ARDS 106 08 (33,3%) 11 (13,4%) 0,035
    Paraclinic        
    Natremia 106     0,2
    Normal   07 (29,2%) 14 (17,1%)  
    Severe hyponatremia   02 (08,3%) 05 (06,1%)  
    Mild to moderate hyponatremia   14 (58,3%) 62 (75,6%)  
    Hypernatremia   01 (04,2%) 01 (01,2%)  
    Kaliemia 106     0,7
    Normal   14 (58,3%) 46 (56,1%)  
    Hypokalemia   02 (08,3%) 11 (13,4%)  
    Mild to moderate hyperkalemia   08 (33,4%) 21 (25,6%)  
    Severe hyperkalémia   00 (00,0%) 04 (04,9%)  
    Severe anemia 106 09 (37,5%) 40 (48,8%) 0,3
    Other        
    Time limit for requesting the opinion 106     0,010
    ≤ 24 hours   12 (50,0%) 44 (53,7%)  
    [1 - 3] days   03 (12,5%) 28 (34,1%)  
    > 3 days   09 (37,5%) 10 (12,2%)  
    Severity of the IRA 106     0,024
    Stage 1   00 (00,0%) 17 (20,7%)  
    Stage 2   05 (20,8%) 06 (07,3%)  
    Stage 3   19 (79,2%) 59 (72,0%)  
    Discussion
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    Epidemiological data

    In our study, the patients were predominantly young adults. This is consistent with the findings of Failal, et al. in Morocco (2020), Konan, et al. in Ivory Coast (2021), and Samake, et al. in Mali (2022) [12–14]. However, these results diverge from data reported in developed countries, where the mean age was generally above 60 years [15,16]. This discrepancy may be explained by demographic characteristics, notably the relatively young age structure of African populations compared to the increasingly aging populations of developed countries.

    Male predominance has been reported in numerous African and Western studies, consistent with the findings of the present study [12,14,15]. However, in Ivory Coast, Yao, et al. (2017) and Guei, et al. (2019) reported female predominance in their studies conducted among HIV-infected patients [17,18]. This finding may be attributed to the higher prevalence of HIV infection among women in this population [19].

    Renal function impairment was the sole indication for AHCO in all cases. Consistent with studies on initial and follow-up nephrology consultations conducted in Senegal, Australia, and Great Britain, renal function impairment represented the primary reason for referral to nephrology expertise [20–22]. It is worth noting, however, that in our region, the indications for nephrology referral are considerably less varied compared to those reported in developed countries. Indeed, the diagnosis of kidney disease typically arises in two distinct clinical situations: on the one hand, during the follow-up of patients at risk, such as those with hypertension, diabetes mellitus, or autoimmune disease; and on the other hand, in the presence of clinical signs suggestive of kidney injury. In both situations, the need for referral to specialized nephrology care should be systematically assessed in accordance with the recommendations of learned societies [10,23].

    Diagnostic and prognostic data

    The majority of patients (73.6%) presented at stage 3 of the KDIGO classification, with a considerable proportion requiring emergency dialysis (30.2%). These findings are consistent with those reported by Guei ,et al. (61.6% at stage 3), and suggest late diagnosis and/or delayed management of patients [18]. Favre, in a study on the timing of nephrology consultation requests, recommends a referral delay of less than 2 hours to avoid missing a vital emergency; yet in the present series, the mean time to specialist consultation request was 2.6 ± 2.5 days [24]. These data highlight a significant weakness in our healthcare system, namely the delayed response of healthcare staff to clinical deterioration.

    Complete recovery was recorded in 28.3% of cases and partial recovery in 24.5%. Lengani et al. reported higher rates in Burkina Faso, with complete recovery in 41.3% and partial recovery in 36.4% of cases [25]. According to the literature, approximately 63% of patients regained their baseline renal function following an episode of AKI, with a lower proportion observed among patients with pre-existing chronic kidney disease (CKD) [26]. The dialysis withdrawal rate of 63.2% observed in the present study is consistent with data from the literature, which reports rates ranging from 40% to 70% [27–29].

    The mortality rate in the present study was 22.6%. With an estimated 1.7 million deaths attributed to acute kidney disease annually worldwide, the close association between AKI and mortality is well established [30].

    In numerous studies on AKI, the risk of mortality has been correlated with the severity of renal impairment and associated vital organ failures [26,28]. The findings of the present study are consistent with these observations, identifying a significantly increased risk of death associated not only with coma (p = 0.014), left heart failure (p = 0.009), and acute respiratory distress syndrome (ARDS) (p = 0.035), but also with the severity of AKI (p = 0.024) and a delay in requesting nephrology consultation exceeding 3 days (p = 0.010). The latter finding further supports the growing body of evidence suggesting that early specialized nephrology care is associated with a reduction in mortality [6,31–33].

    Conclusion
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    Our working hypothesis is confirmed with a risk of death associated with the severity of kidney damage and a delay in requesting consultation of more than 3 days. AKI in our countries predominantly affects young adult males, with infectious etiologies representing the leading cause. Despite the advent of renal replacement therapy, which has substantially transformed the management of severe renal failure, mortality rates remain unacceptably high, largely attributable to delayed diagnosis and referral to specialized care. These findings highlight the critical importance of a comprehensive and coordinated approach, encompassing public awareness campaigns, improved access to nephrology care, and the continuous training of healthcare personnel on the clinical benefits of early specialized nephrology intervention. Further prospective multicenter studies are warranted to better characterize the epidemiological and clinical profile of AKI in our countries and to inform evidence-based nephrology care policies.

    References
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    33. Smart NA, Dieberg G, Ladhani M, Titus T. Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease. Cochrane Database of Systematic Reviews. 2014; 18(6):CD007333. Available from: https://doi.org/10.1002/14651858.cd007333.pub2