Acute Kidney Injury in Patients Presenting with Severe Diarrhea at the Outpatient Department of Peshawar Institute of Medical Sciences, Peshawar

Abstract

Background: Diarrheal diseases remain a major cause of morbidity in low- and middle-income countries, and severe fluid losses can precipitate acute kidney injury (AKI). In resource-limited settings, diarrhea-related AKI contributes to significant morbidity and mortality but remains under-studied in Pakistan.

Methods: A cross-sectional study was conducted from January to July 2025 at the Outpatient Department (OPD) of Peshawar Institute of Medical Sciences. Patients aged ≥15 years presenting with severe acute diarrhea were evaluated for AKI based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographic, clinical, and laboratory data were recorded. Logistic regression was performed to assess risk factors for AKI.

Results: Of 240 patients enrolled, 58 (24.1%) developed AKI. The mean age of AKI patients was 42.3±17.8 years compared to 34.1±15.6 years in non-AKI patients (p=0.01). Male gender (AOR=1.8; 95% CI: 1.0–3.3), hypotension at presentation (AOR=2.6; 95% CI: 1.4–4.7), and serum sodium <130 mmol/L (AOR=2.2; 95% CI: 1.1–4.3) were independent predictors of AKI.

Conclusion: Nearly one in four patients with severe diarrhea at PIMS developed AKI, highlighting the importance of early fluid resuscitation, electrolyte monitoring, and risk stratification. Strengthening diarrheal care pathways could reduce preventable AKI burden in Peshawar.

Keywords: Acute kidney injury, Diarrhea, Electrolyte imbalance, Peshawar, Public health