Acute renal failure in the tropics: emerging trends from a tertiary care hospital in South India

Anandh, Urmila; Renuka, S; Somiah, Surjit; Vincent, Logan

doi:10.5414/cnp59341

Cited by 9 publications

(7 citation statements)

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“…The overall mortality rate (22%) was lower than previously reported in developed and emerging countries (2,16,24), and the mortality rate in patients receiving RRT (32.3%) was much lower than in BEST (60.3%) and PICARD (45.3%) (2,44). These results are probably related to higher mean APACHE scores in PICARD (86 versus 56 in our study) (16).…”

Section: Discussioncontrasting

confidence: 55%

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A Prospective International Multicenter Study of AKI in the Intensive Care Unit

Bouchard

Acharya

Cerdá

et al. 2015

Clinical Journal of the American Society of Nephrology

226

166

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Background and objectives AKI is frequent and is associated with poor outcomes. There is limited information on the epidemiology of AKI worldwide. This study compared patients with AKI in emerging and developed countries to determine the association of clinical factors and processes of care with outcomes.Design, setting, participants, & measurements This prospective observational study was conducted among intensive care unit patients from nine centers in developed countries and five centers in emerging countries. AKI was defined as an increase in creatinine of $0.3 mg/dl within 48 hours.Results Between 2008 and 2012, 6647 patients were screened, of whom 1275 (19.2%) developed AKI. A total of 745 (58% of those with AKI) agreed to participate and had complete data. Patients in developed countries had more sepsis (52.1% versus 38.0%) and higher Acute Physiology and Chronic Health Evaluation (APACHE) scores (mean6SD, 61.1627.5 versus 51.1625.2); those from emerging countries had more CKD (54.3% versus 38.3%), GN (6.3% versus 0.9%), and interstitial nephritis (7.0% versus 0.6%) (all P,0.05). Patients from developed countries were less often treated with dialysis (15.5% versus 30.2%; P,0.001) and started dialysis later after AKI diagnosis (2.0 [interquartile range, 0.75-5.0] days versus 0 [interquartile range, 0-5.0] days; P=0.02). Hospital mortality was 22.0%, and 13.3% of survivors were dialysis dependent at discharge. Independent risk factors associated with hospital mortality included older age, residence in an emerging country, use of vasopressors (emerging countries only), dialysis and mechanical ventilation, and higher APACHE score and cumulative fluid balance (developed countries only). A lower probability of renal recovery was associated with residence in an emerging country, higher APACHE score (emerging countries only) and dialysis, while mechanical ventilation was associated with renal recovery (developed countries only).Conclusions This study contrasts the clinical features and management of AKI and demonstrates worse outcomes in emerging than in developed countries. Differences in variations in care may explain these findings and should be considered in future trials.

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Section: Discussioncontrasting

confidence: 55%

“…Studies from developing countries have shown that AKI incidence varies (14,(19)(20)(21)(22)(23) and that AKI is often community acquired and preventable (i.e., due to gastroenteritis and infections) (23)(24)(25)(26)(27). However, a formal comparison between developed and emerging countries is lacking (14,28).…”

Section: Introductionmentioning

confidence: 99%

A Prospective International Multicenter Study of AKI in the Intensive Care Unit

Bouchard

Acharya

Cerdá

et al. 2015

Clinical Journal of the American Society of Nephrology

226

166

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“…[2728293031] Severe diarrhea and PSGN form a large proportion of children with AKI in India. [3233] In our study, acute glomerulonephritis (predominantly PSGN) accounted for 7.6% of patients. Diarrhea leading to AKI was uncommonly encountered.…”

Section: Discussionmentioning

confidence: 63%

Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study

Krishnamurthy

Parameswaran

Prabha

et al. 2013

Indian Journal of Critical Care Medicine

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Background:Although the term acute renal failure was replaced by acute kidney injury (AKI) recently, there is a paucity of data on the incidence and profile of AKI in critically ill children from the developing world.Objectives:The objective of this study is to determine the incidence, etiology, short term outcome and predictors of fatality in critically ill children admitted to the pediatric intensive care unit (PICU) with AKI, aged 1 month to 13 years.Materials and Methods:In this prospective observational study, from June 2010 to March 2011, 215 children admitted to the PICU were screened for AKI, defined according to the AKI Network criteria. The patients with AKI were followed-up until discharge/death. Their clinical and biochemical data were recorded.Results:The incidence of AKI among 215 patients screened was 54 (25.1%). The common etiologies were infections, [34 (62.9%)], acute glomerulonephritis (7.6%), snake envenomation (5.7%), hemolytic uremic syndrome (3.8%) and congestive cardiac failures (3.8%). Among infections, pneumonia and septicemia constituted 26.5% each, meningoencephalitis accounted for 23.5%, and dengue, scrub typhus, tuberculosis and malaria constituted 9.3% of children with AKI. 27.8% of patients required dialysis. Overall mortality was 46.3%. On logistic regression analysis, requirement of mechanical ventilation was an independent predictor of fatality in AKI.Conclusions:Besides the high incidence of AKI in critically ill-children admitted to the PICU (25.1%), the condition was associated with adverse outcomes, including high mortality (46.3%) and need for dialysis (27.8%). Infections dominated the etiological profile. Requirement of mechanical ventilation predicted an adverse outcome in our patient population.

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“…However, sub-Saharan African (SSA) countries face the dual burden of non-communicable and transmissible diseases which may predispose to an increase in prevalence and a modified spectrum of kidney diseases [ 8 ]. Despite epidemiological transition in this setting, CKD remains the leading kidney disease, affecting predominantly young male adults, in their economically productive years, with chronic glomerulonephritis, hypertension and diabetes as the main etiological factors [ 9 – 16 ] while AKI is mainly secondary to diarrhea, obstetric complications, toxins and infections [ 17 , 18 ]. Few countries in SSA have nephrologists and where available, nephrology units are under-equipped and understaffed; hence, patients with kidney diseases are generally managed in general internal medicine wards [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The clinical pattern of renal diseases in the nephrology in-patient unit of the Yaounde General Hospital in Cameroon: a five-year audit

Kaze¹,

Ekokobe²,

Halle³

et al. 2015

Pan Afr Med J

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IntroductionKidney diseases are a growing worldwide problem and one of the major public health threats. We analyzed the spectrum of kidney diseases seen over a five-year period in the nephrology in-patient unit of the Yaounde general hospital.MethodsThis was a retrospective analysis of 225 medical records of patients admitted from January 2005 to December 2009 in the unit with a discharge diagnosis of kidney and urinary tract diseases. The first hospitalization was considered for patients admitted several times for the same disease. Socio-demographic and clinical patient data were recorded.ResultsThe patients mean age was 44.8±16 years with 135 (60%) males and 211 (93.8%) emergency admissions. All 139 (61.8%) patients with chronic kidney disease (CKD) had chronic renal failure. Acute kidney injury (AKI) (28%), nephrotic syndrome (7.6%), renal colic (1.3%) and acute pyelonephritis (1.3%) were other patterns observed. Chronic glomerulonephritis (25.9%), hypertension (22.3%) and diabetes (20.1%) were the main etiological factors of CKD. All AKI patients were in stage RIFLE-F. AKI was secondary to parenchymal (58.7%), functional (25.4%) and obstructive (15.9%) etiologies. Black water fever (36.4%), sepsis (22.7%), drugs (18.2%), eclampsia (13.6%) and herbal concoctions (9.1%) were the etiologies of acute tubular necrosis while enterocolitis (56.2%), heart failure (31.3%) and digestive hemorrhage (12.5%) were the etiologies of functional AKI.ConclusionThe clinical pattern of renal diseases is dominated by advanced CKD and AKI secondary to preventable causes. This study suggests a need for an array of actions including sensitization, continuous medical education and strengthening of the health system.

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Acute renal failure in the tropics: emerging trends from a tertiary care hospital in South India

Abstract: Sepsis continues to be the predominant cause of ARF. Overall mortality of our patients is better, because of the case mix, a large percentage of patients had acute gastroenteritis as a cause of CRF.

Cited by 9 publications

References 0 publications

A Prospective International Multicenter Study of AKI in the Intensive Care Unit

A Prospective International Multicenter Study of AKI in the Intensive Care Unit

Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study

The clinical pattern of renal diseases in the nephrology in-patient unit of the Yaounde General Hospital in Cameroon: a five-year audit

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