Epidemiological profile of acute kidney injury in critically ill patients admitted to intensive care units: A Prospective Brazilian Cohort

Abstract

Introduction Acute kidney injury (AKI) is a frequent syndrome affecting patients admitted to intensive care units (ICU), and it is associated with poor clinical outcomes. The aim of the present study was to understand the epidemiological profile of patients with AKI admitted to ICUs. Methods Prospective cohort study, carried out in three ICUs in the Federal District, Brazil. Between October/2017 and December/2018, 8,131 patients were included in the cohort. AKI was defined according to the KDIGO criteria. The main outcomes assessed were AKI development and mortality within 28 days of hospitalization. Results Of the 8,131 patients followed up, 1,728 developed AKI (21.3%). Of the 1,728 patients with AKI, 1,060 (61.3%) developed stage 1, while stages 2 and 3 represented 154 (8.9%) and 514 (29.7%), respectively. Of these, 459 (26.6%) underwent renal replacement therapy. The mortality was 25.7% for those with AKI, and 4.9% for those without AKI. Discussion Patients with AKI had higher mortality rates when compared to those without AKI. Likewise, among patients with AKI, higher disease stages were associated with higher death occurrences. AKI incidence (21.3%) and mortality (25.7%) in our study is in line with the largest meta-analysis ever conducted, in which incidence and mortality of 21.6 and 23.9% were observed, respectively. These findings confirm the importance of establishing the KDIGO guideline for the definition and management of AKI in Brazilian ICUs.

Características clínicas y pronóstico del fracaso renal agudo puro vs. fracaso renal agudo sobre enfermedad renal crónica

“…Al comparar la clasificación del FRA según las guías KDIGO-2012, con respecto a la distribución global en los estadios, hallamos que una proporción mayor del grupo AsERC son clasificados en el Estadio KDIGO-1, esta proporción se invierte en el Estadio KDIGO-2 y se iguala en el Estadio KDIGO-3; una peculiaridad del Estadio KDIGO-2 es la baja proporción de pacientes que se catalogan en esta franja en ambos grupos (IRAp 19%, AsERC 10% P < 0.001) (ver tabla 4), pero este dato no es tan excepcional y se ha visto en pacientes no críticos ( 81,82 ), de UCI general ( 83,84 ) y REA cardiaca ( 85 ), algunos autores explican este fenómeno por el paso automático de los pacientes que requieren HD al Estadio KDIGO-3. A este respecto y como excepción a la regla, encontramos un grupo especial de pacientes donde la proporción de individuos en el Estadio KDIGO-2 aumenta y es en los pacientes que sufren COVID-19 ( 86,87 ), este hallazgo no es analizado por los autores, y profundizar en las causas de esta diferencia supera al ámbito de este estudio.…”