Critical Care and Shock

Clinical spectrum and outcomes of acute kidney injury: A prospective study from an intensive care unit of South India

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Abstract

Introduction: The prevalence of acute kidney injury (AKI) among hospitalized patients in the United States of America is around 5-7%, and that among Intensive Care Units (ICU) is 30%. The mortality and morbidity associated with AKI are immense, and the prevalence has been increasing over the past decades. However, the data on the prevalence, profile, and outcome of AKI in hospitalized patients from the developing world is meager.

Objective: This study aimed at determining the common etiologies and clinical profile of AKI patients in the ICU of a tertiary care center, in South India and to assess the outcome of AKI in community-acquired and hospital-acquired AKI patients with respect to its etiology.

Materials and methods: This study was designed to be a prospective observational study. We included 150 patients who were either directly admitted to ICU or transferred from ward to ICU, in our tertiary care center, who had AKI either at admission or during the course in the hospital. They were followed up until discharge/death and their clinical and biochemical data were studied.

Results: The causes of AKI were grouped as acute tubular necrosis (56%), volume loss/hypoperfusion (26%), acute interstitial nephritis (12%), urinary tract obstruction (4.7%), and glomerulonephritis (1.3%). The major contributing illness for AKI was sepsis (including septic shock) (28.7%). The other common causes were nephrotoxins (24%), acute gastroenteritis (13.3%), pyelonephritis (7.3%), and urinary tract obstruction (4.7%). Among the subjects, 82.7% had community-acquired AKI and 17.3% had hospital-acquired AKI. Most of the patients (60%) recovered from AKI, whereas 36% had partial recovery, one person was dependent on renal replacement therapy (0.7%), and death occurred in 3.3% (n=5). The outcome between community-acquired and hospital-acquired AKI was statistically non-significant.

Conclusion: Sepsis and nephrotoxins were the most common causes of AKI in our study. Community-acquired AKI was more prevalent than hospital-acquired AKI. The mortality rate of AKI patients in the ICU was less (3.3%).