Citation Information :
Sundar S, Korula S, Balakrishnan S, Paul V, Balagopal A. Acute kidney injury-incidence, prognostic factors, and outcome of patients in an Intensive Care Unit in a tertiary center: A prospective observational study. Indian J Crit Care Med 2016; 20 (6):332-336.
Background and Aims: The information regarding the incidence of acute kidney injury (AKI) in medical Intensive Care Units (ICUs) in South India is limited. The aim of the study was to find the incidence, prognostic factors, and outcome of patients with AKI. We also assessed whether only urine output criteria of risk, injury, failure, loss, end (RIFLE) classification can be used to look at the outcome of AKI.
Patients and Methods: This was a prospective, cross-sectional study of 6 months duration in a 28 bedded medical ICU of a tertiary center. AKI was defined as an absolute creatinine value of>1.6 mg/dl or a 25% increase from baseline creatinine values.
Results: The incidence of AKI was 16.1%, and mortality was 7.8% in our study population. Among patients with AKI 87 (75.7%) patients had sepsis. 71.3% patients had metabolic acidosis on admission, and 47.8% patients were in shock. 57.4% of patient's required mechanical ventilation (MV). 39.1% of AKI patients required renal replacement therapy (RRT). Requirement of RRT was significantly affected by increasing age, Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores on admission, serum creatinine, and use of vasopressors. 49.5% of patients with AKI died within 28 days. Increasing age, MV, hemodialysis (HD), hypertension, chronic kidney disease, and requirement of noradrenaline support were associated with increasing 28 days mortality. The maximum RIFLE score with urine output criteria showed association to the requirement of HD in univariate analysis but did not show relation to mortality.
Conclusion: The incidence of AKI was 16.1% in critically ill patients. In patients with AKI, 39.1% patients required HD and 28 days mortality was 49.5%. The study also showed good univariate association of urine output criteria of RIFLE classification to the requirement of HD in AKI patients.
Hoste EA, Schurgers M. Epidemiology of acute kidney injury: How big is the problem? Crit Care Med 2008;36 4 Suppl: S146-51.
Prakash J, Singh TB, Ghosh B, Malhotra V, Rathore SS, Vohra R, et al. Changing epidemiology of community-acquired acute kidney injury in developing countries: Analysis of 2405 cases in 26 years from eastern India. Clin Kidney J 2013;6:150-5.
Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract 2013;2013:479730.
Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, et al. An official ATS/ERS/ESICM/SCCM/SRLF statement: Prevention and management of acute renal failure in the ICU patient: An international consensus conference in intensive care medicine. Am J Respir Crit Care Med 2010;181:1128-55.
Gurjar M, Baronia AK, Azim A, Prasad N, Jain S, Singh RK, et al. Septic acute kidney injury in critically ill Indian patients. Indian J Crit Care Med 2013;17:49-52.
Avasthi G, Sandhu JS, Mohindra K. Acute renal failure in medical and surgical intensive care units – A one year prospective study. Ren Fail 2003;25:105-13.
Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: The PICARD experience. Kidney Int 2004;66:1613-21.
ACUTE KIDNEY INJURY, KDIGO. Available from: http://www.kdigo.org/home/guidelines/acute-kidney-injury/. [Last cited on 2015 Feb 09].
Faulhaber-Walter R, Hafer C, Jahr N, Vahlbruch J, Hoy L, Haller H, et al. The hannover dialysis outcome study: Comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. Nephrol Dial Transplant 2009;24:2179-86.
Han SS, Kim S, Ahn SY, Lee J, Kim DK, Chin HJ, et al. Duration of acute kidney injury and mortality in critically ill patients: A retrospective observational study. BMC Nephrol 2013;14:133.
Bagshaw SM. Short- and long-term survival after acute kidney injury. Nephrol Dial Transplant 2008;23:2126-8.
Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: A critical and comprehensive review. Clin Kidney J 2013;6:8-14.
Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1203-10.
Levi TM, de Souza SP, de Magalhães JG, de Carvalho MS, Cunha AL, Dantas JG, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva 2013;25:290-6.
Ratanarat R, Hantaweepant C, Tangkawattanakul N, Permpikul C. The clinical outcome of acute kidney injury in critically ill Thai patients stratified with RIFLE classification. J Med Assoc Thai 2009;92 Suppl 2:S61-7.
Maccariello E, Soares M, Valente C, Nogueira L, Valença RV, Machado JE, et al. RIFLE classification in patients with acute kidney injury in need of renal replacement therapy. Intensive Care Med 2007;33:597-605.