Spectrum of acute kidney injury in critically ill patients: A single center study from South India

Abstract

Acute kidney injury (AKI) is common in intensive care unit (ICU) and carries a high mortality rate. Reliable and comparable data about the clinical spectrum of AKI is necessary for optimizing management. The study was conducted to describe epidemiology, etiology, clinical characteristics and outcome of AKI in critically ill patients without pre-existing renal disease, diagnosed using RIFLE criteria. We retrospectively analyzed data of 500 adult patients admitted to ICU with AKI or who developed AKI in ICU. Patients with pre-existing renal disease, renal transplant recipients were excluded. AKI was predominantly encountered in older males. Diabetes, hypertension, coronary artery disease were the most commonly prevalent comorbidities. Sepsis was the most common cause of AKI, accounting for 38.6% of patients. 24.4% belonged to risk class, 37.0% to injury class, 35.0% to failure class, 3% to loss and 0.6% to ESRD class of the RIFLE criteria. Renal replacement therapy (RRT) was required in 37.2% (n = 186) of patients. About 60% recovered complete renal function. Chronic kidney disease (CKD) was a sequel in 2.4% (n = 12) of patients. Average duration of ICU stay was 5.6 days. Crude mortality rate was 37.6% (n = 188). In critically ill patients without pre-existing renal disease, elderly age, male sex, type 2 diabetes along with a primary diagnosis of sepsis were most commonly associated with AKI. Majority of the patients’ recovered complete renal function.

A study of clinical profile of patients with acute kidney injury in a tertiary care centre.

“…Comparison is also made with other studies done by Eswarappa M [1] and Shah et al [38] Comparison is tabulated below.…”

“…Two trials, namely program to improve care in acute renal disease (PICARD) and Beginning & Ending Supportive Therapy (BEST) for the kidney confirmed that AKI is a significant contributor toward mortality and morbidity. [1] RIFLE classification scheme and acute kidney injury network (AKIN) classification scheme have been proposed to achieve early diagnosis of AKI. Reliable and comparable data about the clinical spectrum of AKI is necessary for optimizing the management.…”

“…However, minimal data is currently available from India using standardized criteria. [1] In India, Acute Kidney Injury constitutes 1.5% of all general hospital admissions, of which 60% are due to medical causes. 2 the most common causes of AKI are: acute diarrhoeal diseases, sepsis, infection (malaria, UTI, pneumonia, viral hepatitis), snake bite, cardiac failure, diabetes mellitus, nephrotoxic drug use, malignancy, SLE, hypertension etc.…”

Acute Kidney Injury in Patients of Intensive Care Unit

“…Chronic kidney disease (CKD) was defined as persistant reduction in eGFR after 3 months with a value<60 ml/min/1.73 m 2 . Mortality was defined as patients expiring during the hospital stay 12,8,13 .…”

Intermittent Hemodialysis Low Intensity vs. on Line Hemodiafiltration in Critically Ill Patients with Sepsis and Acute Kidney Injury. Choosing the Best Treatment in a Developing Country

“…AKI is diagnosed in approximately two thirds of patients in the first 24 hours of their admission to ICU [12,13], RRT is necessary in 37% of these patients, around 60% fully recover kidney function [14].…”