# Reducing mortality in acute kidney disease through comprehensive laboratory support: Findings from the ICLATA hybrid implementation study in Zambia

## TL;DR

A comprehensive clinical laboratory support system significantly reduced mortality and re-hospitalization in acute kidney disease patients in Zambia.

## Contribution

Demonstrated that enhanced laboratory diagnostics improve survival and diagnostic accuracy for acute kidney disease in low-resource settings.

## Key findings

- Mortality rate was significantly lower in the intervention group (5.1%) compared to the non-intervention group (28.2%).
- Diagnostic accuracy improved with fewer misdiagnoses or delayed diagnoses in the intervention group.
- Re-hospitalization was significantly lower in the intervention group (38.6%) compared to the non-intervention group (61.4%).

## Abstract

Acute kidney disease (AKD) contributes significantly to morbidity and mortality, particularly in low-resource settings where limited diagnostic capacity often leads to delayed recognition and suboptimal management. We aimed to evaluate the impact of implementing a comprehensive patient-specific clinical laboratory support on clinical outcomes in AKD and to identify factors associated with mortality. We conducted a mixed-method hybrid type 3 implementation study at Livingstone University Teaching Hospital in Zambia. The study compared a retrospective non-intervention cohort (NIC; n = 39) with a prospective intervention cohort (IC; n = 39) matched for age and sex. The intervention included providing full laboratory diagnostic support for AKD management and additional patient-specific tests. The primary outcome was death within 30 days after admission regardless of whether the patient was discharged before or after the thirty-day period elapsed. Data were analyzed using logistic regression and survival analysis. The median age of the NIC (43 years, IQR 31–53) was comparable to the IC (41 years, IQR 34–53), p = 0.996. Overall, 51.3% (n = 40/78) were males. Mortality rate was significantly lower in the intervention group, with deaths occurring in 5.1% of the IC compared to 28.2% in the NIC (p = 0.012). Logistic regression confirmed the intervention as a strong independent predictor of survival (adjusted odds ratio 0.07, p = 0.009). Diagnostic accuracy improved, with fewer cases of misdiagnosis or delayed diagnosis in the IC (7.7% vs 30.8%, p = 0.019). Re-hospitalization was significantly lower in the IC (38.6% vs 61.4%, p = 0.022). ESRD was more frequently recorded in the IC due to better diagnostics, follow-up and survival. The median time-to-ESRD was substantially longer in the IC compared to NIC (140 vs 21 days, p < 0.0001). Implementation of a comprehensive patient-specific clinical laboratory support for AKD/CKD management significantly improved diagnostic precision and survival and reduced re-hospitalization. These findings highlight the value of strengthening laboratory diagnostic capacity to improve AKD outcomes in low-resource settings.