Prevalence and associated factors of acute kidney injury in intensive care units in Africa: a systematic review and meta-analysis

Acute kidney injury (AKI) is a major global public health challenge associated with increased mortality and progression to chronic kidney disease. The burden is particularly pronounced among critically ill patients in intensive care units (ICUs). This systematic review and meta-analysis aimed to estimate the pooled prevalence of AKI and identify factors associated with AKI among patients admitted to ICUs in Africa. A systematic review and meta-analysis of observational studies was conducted. PubMed, Cochrane Library, African journals Online (AJOL), Hinari, Scopus, Web of Science, Google Scholar, ProQuest, OpenGrey, and ClinicalTrials.gov were searched from inception to January 10, 2026. Studies reporting AKI prevalence, incidence, or associated factors among adult ICU patients in Africa were included. Pooled prevalence estimates and pooled odds ratios (PAOR) were calculated using random-effects models with the Restricted Maximum Likelihood (REML) estimator. Heterogeneity was assessed using the I 2 statistic. The review was registered with PROSPERO (CRD420261277724). Sixteen studies comprising 6,005 patients from nine African countries were included. The pooled prevalence of AKI was 37.79% (95% CI: 29.90–45.67), with substantial heterogeneity (I 2 = 97.93%). Factors significantly associated with AKI included sepsis (PAOR = 3.36, 95% CI: 2.07–5.45), hypovolemia (PAOR = 3.06, 95% CI: 1.36–6.87), mechanical ventilation (PAOR = 2.79, 95% CI: 1.70–4.60), inotropic support (PAOR = 2.73, 95% CI: 1.55–4.80), older age (PAOR = 2.53, 95% CI: 1.52–4.22), diabetes mellitus (PAOR = 2.51, 95% CI: 1.72–3.67), vasopressor support (PAOR = 2.19, 95% CI: 1.63–2.95), and hypertension (PAOR = 1.76, 95% CI: 1.23–2.51). The pooled prevalence of AKI among adult patients admitted to African ICUs was 37.79%. Key factors associated with AKI include sepsis, hypovolemia, mechanical ventilation, inotropic support, older age, diabetes mellitus, vasopressor support, and hypertension.