Acute kidney injury in Malaysian intensive care setting: Incidences, risk factors, and outcome
Azrina Ralib, Suhaila Nanyan, Nur Ramly, Lim Har, Tan Cheng, Mohd Mat Nor
Acute kidney injury, epidemiology, intensive care unit, mortality, risk factors
Citation Information :
Ralib A, Nanyan S, Ramly N, Har L, Cheng T, Mat Nor M. Acute kidney injury in Malaysian intensive care setting: Incidences, risk factors, and outcome. Indian J Crit Care Med 2018; 22 (12):831-835.
Introduction: Acute kidney injury (AKI) is common in the intensive care unit (ICU) with a high risk of morbidity and mortality. The high incidence of AKI in our population may be attributed to sepsis. We investigated the incidence, risk factors, and outcome of AKI in four tertiary Malaysian ICUs. We also evaluated its association with sepsis.
Materials and Methods: This retrospective cohort study extracted de-identified data from the Malaysian Registry of Intensive Care in four Malaysian tertiary ICUs between January 2010 and December 2014. The study was registered under the NMRR and approved by the ethics committee. AKI was defined as twice the baseline creatinine or urine output <0.5 ml/kg/h for 12 h.
Results: Of 26,663 patients, 24.2% had AKI within 24 h of admission. Patients with AKI were older and had higher severity of illness compared to those without AKI. AKI patients had a longer duration of mechanical ventilation, length of ICU, and hospital stay. Age, Simplified Acute Physiological II Score, and the presence of sepsis and preexisting hypertension, chronic cardiovascular disease independently associated with AKI. About 32.3% had sepsis. Patients with both AKI and sepsis had the highest risk of mortality (relative risk 3.43 [3.34–3.53]).
Conclusions: AKI is common in our ICU, with higher morbidity and mortality. Independent risk factors of AKI include age, the severity of illness, sepsis and preexisting hypertension, and chronic cardiovascular disease. AKI independently contributes to mortality. The presence of AKI and sepsis increased the risk of mortality by three times.
Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA, et al. Acute renal failure in patients with sepsis in a surgical ICU: Predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol 2003;14:1022-30.
Md Ralib A, Mat Nor MB. Acute kidney injury in a Malaysian intensive care unit: Assessment of incidence, risk factors, and outcome. J Crit Care 2015;30:636-42.
Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007;35:1837-43.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005;294:813-8.
Liaño F, Pascual J. Epidemiology of acute renal failure: A prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996;50:811-8.
Singbartl K, Kellum JA. AKI in the ICU: Definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012;81:819-25.
Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2:431-9.
Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units – Causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996;24:192-8.
Ministry of Health. Malaysian Registry of Intensive Care Report for 2015. Kuala Lumpur: Malaysian Registry of Intensive Care, Clinical Research Centre; 2015.
Vieira JM Jr., Castro I, Curvello-Neto A, Demarzo S, Caruso P, Pastore L Jr., et al. Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients. Crit Care Med 2007;35:184-91.
Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 2010;38:933-9.
Cartin-Ceba R, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET, et al. Risk factors for development of acute kidney injury in critically ill patients: A systematic review and meta-analysis of observational studies. Crit Care Res Pract 2012;2012:691013.
Finlay S, Bray B, Lewington AJ, Hunter-Rowe CT, Banerjee A, Atkinson JM, et al. Identification of risk factors associated with acute kidney injury in patients admitted to acute medical units. Clin Med (Lond) 2013;13:233-8.
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;12:43.
Md Ralib A, Mat Nor MB, Pickering JW. Plasma neutrophil gelatinase-associated lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis. Nephrology (Carlton) 2017;22:412-9.
Ralib AM, Nanyan S, Mat Nor MB. Dynamic changes of plasma neutrophil gelatinase-associated lipocalin predicted mortality in critically ill patients with systemic inflammatory response syndrome. Indian J Crit Care Med 2017;21:23-9.
Vanmassenhove J, Vanholder R, Nagler E, Van Biesen W. Urinary and serum biomarkers for the diagnosis of acute kidney injury: An in-depth review of the literature. Nephrol Dial Transplant 2013;28:254-73.
Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med 2004;351:159-69.
Bagshaw SM, Uchino S, Cruz D, Bellomo R, Morimatsu H, Morgera S, et al. A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury. Nephrol Dial Transplant 2009;24:2739-44.
Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med 2005;118:827-32.
Liaño F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl 1998;66:S16-24.
Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: A prospective study. Am J Med 1983;74:243-8.
Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39:930-6.
Md Ralib A, Pickering JW, Shaw GM, Endre ZH. The urine output definition of acute kidney injury is too liberal. Crit Care 2013;17:R112.