Etiological Factors and Clinical Profile of Acute Kidney Injury in Medical Intensive Care Unit
Abstract
Background and Objectives
Data on the etiology, management practices and outcome in patients admitted to intensive care units in Kerala has not been studied in depth. The etiology and patterns of AKI, as well as management practices are likely to differ in countries with resource limitations and variations in disease patterns. The present study was undertaken to identify the etiologic factors and outcome of patients with Acute Kidney Injury admitted in Medical ICU.
Methods
The study is a cross sectional study, done in 150 consecutive patients admitted to Medical Intensive Care Unit, Government Medical College, Kottayam meeting the AKIN creatinine criteria for acute kidney injury over a period of 12 months.
Results and Discussion
The most common diagnosis in the patients admitted with AKI in MICU was Leptospirosis (22%) followed by undifferentiated fever (21%) and sepsis seen in 17%. Dialysis was required in 81.3% among those with undifferentiated febrile illness and 78.8% among those with leptospirosis. Significant association was identified between etiology of AKI and the need for dialysis. The most common stage of AKI in the patients in this study group on admission to the medical intensive care unit was stage 3 in 64.7%. 45% of the patients required dialysis, among which 24% underwent CRRT while the 76% underwent hemodialysis.
Out of 150 cases 59% survived and 41% expired. Mortality was more in the patients in this study with undifferentiated acute febrile illness, 43.8% and leptospirosis, 36.4%. Mortality was 48.5% in those who underwent dialysis. But no significant association was identified between requirement of dialysis or diagnosis and mortality. Significant association was identified between patients with breathlessness, basal crepitations, later stage of AKI, inotropic support, ventilator support and mortality with p value <0.05.
By logistic regression analysis of the factors having association with mortality, requirement of ventilator support and inotropic supports were independent predictors of mortality.
Conclusion
The most common etiology was leptospirosis (22%) followed by undifferentiated fever (21%). Mortality was 41% in the patients in the study group. Requirement of ventilator support and inotropic supports were independent predictors of mortality.
Full text article
References
2. Prakash J, Murthy AS, Vohra R, Rajak M, Mathur SK. Acute renal failure in intensive care unit (ICU). JAPI vol 54 (2006): 724-728.
3. Uchino S. Acute Renal Failure in Critically Ill Patients. A Multinational, Multicenter Study. JAMA. 2005; 294(7):813.
4. Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous C. Acute kidney injury criteria predict outcomes of critically ill patients*. Critical Care Medicine. 2008; 36(5):1397-1403.
5. Sushrut S.Waikar, Joseph V. Bonventre. Acute kidney injury. Harrison’s principles of internal medicine. 18th edition. New York: McGraw Hill; 2011. 2293-2308.
6. Eswarappa M, Gireesh M, Ravi V, Kumar D, Dev G. Spectrum of acute kidney injury in critically ill patients: A single center study from South India. Indian Journal of Nephrology. 2014; 24(5):280.
7. Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W et al. Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based Study. Journal of the American Society of Nephrology. 2007; 18(4):1292-1298
8. Singbartl K, Kellum J. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney International. 2012; 81(9):819-825.
9. Case J, Khan S, Khalid R, Khan A. Epidemiology of Acute Kidney Injury in the Intensive Care Unit. Critical Care Research and Practice. 2013; 2013:1-9.
10. Cruz D, Bolgan I, Perazella M, Bonello M, de Cal M, Corradi V et al. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): Targeting the Problem with the RIFLE Criteria. Clinical Journal of the American Society of Nephrology. 2007; 2(3):418-425.
11. Bandara K, Weerasekera M, Gunasekara C, Ranasinghe N, Marasinghe C, Fernando N. Utility of modified Faine’s criteria in diagnosis of leptospirosis. BMC Infectious Diseases. 2016; 16(1).
12. Bernieh B, Levy DW. Chaudhuri MD. Pattern of acute renal failure 2003;36:1780-1783
13. Wijewickrama E, Ratnayake G, Wikramaratne C, Sheriff R, Rajapakse S. Incidences and clinical outcomes of acute kidney injury in ICU: a prospective observational study in Sri Lanka. BMC Research Notes. 2014; 7(1):305.
14. Basu G, Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, et al. Acute kidney injury in tropical acute febrile illness in a tertiary care centre--RIFLE criteria validation. Nephrol Dial Transplant 2011; 26:524-31.
15. Liaño F, Pascual J. The Madrid Acute Renal Failure Study Group. Epidemiology of acute renal failure: A prospective, multicenter, community-based study. Kidney International. 1996; 50(3):811-818.
16. Daher Ede F, Junior Silva GB, Vieira AP, Souza JB, Falcão Fdos S, Costa CR, et al. Acute kidney injury in a tropical country: A cohort study of 253 patients in an infectious diseases Intensive Care Unit. Rev Soc Bras Med Trop. 2014; 47:86–9.
17. Chugh KS, Sitprija V, Jha V. Acute renal failure in tropical countries. Davidson AM, Cameron JS, Grunfeld JP, Ronco C et al, editors. Oxford textbook of clinical nephrology. 3rd edition. Oxford University Press. 2005. 639–58.
18. Medve L, Antek C, Paloczi B, Kocsi S, Gartner B, Marjanek Z et al. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study. BMC Nephrol 2011; 13:12-43.
19. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29:1303-10.
20. Jha V, Chugh KS. Community-acquired acute kidney injury in Asia. Semin Nephrol. 2008;28(4):330-47
21. Mathew AJ, George J. Acute kidney injury in the tropics. Ann Saudi Med. 2011; 31(5):451-6
22. Kumar S., Raina S., Vikrant S., Patial R. K. Spectrum of acute kidney injury in the Himalayan region; Indian journal of Nephrology: 2012; 22 (5): 363-366.
23. Ibrahim A, Ahmed M, Kedir S, Bekele D. Clinical profile and outcome of patients with acute kidney injury requiring dialysis—an experience from a haemodialysis unit in a developing country. BMC Nephrology. 2016;17(1).
24. Bhadade R, De’Souza R, J Harde M, S Mehta K, Bhargava P. A Prospective Study of Acute Kidney Injury According to KDIGO Definition and its Mortality Predictors. Journal of The Association of Physicians of India. 2016;64:22-28.
25. Lopes J, Fernandes P, Jorge S, Gonçalves S, Alvarez A, Costa e Silva Z et al. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Critical Care. 2008;12(4):R110.
26. De Francesco Daher E, Soares D, de Menezes Fernandes A, Girão M, Sidrim P, Pereira E et al. Risk factors for intensive care unit admission in patients with severe leptospirosis: a comparative study according to patients’ severity. BMC Infectious Diseases. 2015;16(1).