Abstract Background: Acute kidney injury (AKI) occurring in people living with HIV (PLWH) remains a significant clinical challenge in low- and middle-income countries (LMICs). This study aimed to evaluate the utility of immunovirological status, comorbidity burden, and dialysis indications in predicting six-month outcomes in PLWH undergoing emergency haemodialysis. Methods: A retrospective study of 150 patients with PLWH who received emergency dialysis for AKI between 2018 and 2023. Predictors of six-month mortality were assessed using multivariable logistic regression. Frailty was measured via the Clinical Frailty Scale (CFS), and the AEIOU (Acidosis, Electrolyte imbalances, Intoxications, fluid Overload, and Uraemia) criteria were applied to dialysis triggers. Results: The study cohort had a mean age of 46.3±13.8 years, 57.3% were male, 40.7% were hypertensive, and 28% had diabetes. CD4 count and HIV viral load were strong predictors of six-month mortality (p<0.001). Patients with advanced immunosuppression and detectable viraemia had a mortality rate of 72.2%, compared with 4.1% in those with preserved immunity and viral suppression (p<0.001). Frailty was present in 22 % and was independently associated with mortality. The AEIOU indicators were not predictive of mortality (p=0.322). Conclusion: In PLWH with AKI, frailty and immunovirological compromise superseded acute dialysis indications in predicting six-month mortality. These findings advocate for the integration of frailty and HIV disease markers into dialysis triage protocols in LMICs to optimise survival outcomes.
Moodley et al. (2026) studied this question.