Citation Information :
Nandagopal N, Ranganathan L, Annigeri R. Comparison of Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Patients with and without Sepsis. Indian J Crit Care Med 2020; 24 (4):258-262.
Objectives: In critically ill patients, acute kidney injury (AKI) and sepsis often coexist. This confounds the assessment of outcomes of both sepsis and AKI in these patients. Hence, in this study, we compare the outcomes of AKI with sepsis, AKI without sepsis, and sepsis without AKI against a control cohort comprising patients with neither AKI nor sepsis. Materials and methods: Prospective observational study conducted in our critical care unit (CCU) between January and July 2009. Data including demographic details, acute physiology and chronic health evaluation (APACHE) III score, presence of AKI, presence of sepsis, intensive care unit (ICU) length of stay (LOS), and outcomes were collected for all patients. Acute Kidney Injury Network (AKIN) criteria were used to define the presence of AKI and American College of Critical Care Medicine 2001 definition was used to define the presence of sepsis. Results: A total of 250 patients were included in the study and 8 patients were excluded from analysis as they were discharged from hospital against medical advice. The remaining 242 patients (mean age 52.8 ± 17 years; 61.6% male; APACHE III score: 48.2 ± 24.1) were analyzed, and AKI was seen in 111 patients (45.8%). Among the patients with AKI, 55.8% (62/111) had sepsis and 44.2% (49/111) had nonseptic AKI. There was a higher need for renal replacement therapy (RRT) among patients with septic AKI in comparison to those with nonseptic AKI (19.3% vs 6.1%; p = 0.04), but no mortality difference was seen between the two groups (25.8% vs 20.4%, p = 0.5). Patients with sepsis and AKI had a significantly higher mortality (25.8%) compared to the patients with sepsis alone (5.6%; p < 0.01). Conclusion: Patients with septic AKI had a higher RRT requirement compared to patients with nonseptic AKI, but no significant differences in mortality were seen between the groups. Occurrence of AKI in septic patients substantially increases their mortality.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Beginning and ending supportive therapy for the kidney (BEST kidney) investigators: acute renal failure in critically-ill patients: a multinational, multicenter study. J Am Med Assoc 2005;294(7): 813–818. DOI: 10.1001/jama.294.7.813.
Korkeila M, Ruokonen E, Takala J. Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med 2000;26(12):1824–1831. DOI: 10.1007/s001340000726.
Manns B, Doig CJ, Lee H, Dean S, Tonelli M, Johnson D, et al. Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med 2003;31(2):449–455. DOI: 10.1097/01.CCM.0000045182. 90302.B3.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am SocNephrol 2005;16(11):3365–3370. DOI: 10.1681/ASN.2004090740.
Reddy NPK, Ravi KP, Dhanalakshmi P, Annigeri R, Ramakrishnan N, Venkataraman R. Epidemiology, outcomes and validation of RIFLE and AKIN criteria in acute kidney injury in critically-ill patients: Indian perspective. Ren Fail 2014;36(6):831–837. DOI: 10.3109/0886022X.2014.899432.
Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Beginning and ending supportive therapy for the kidney (BEST kidney) investigators. Septic acute kidney injury in critically-ill patients: clinical characteristics and outcomes. Clin J Am SocNephrol 2007;2(3):431–439. DOI: 10.2215/CJN.03681106.
Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P. Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The french study group on acute renal failure. Nephrol Dial Transplant 1996;11(2):293–299. DOI: 10.1093/oxfordjournals.ndt.a027256.
Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA. Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol 2003;14(4):1022–1030. DOI: 10.1097/01.asn.0000059863.48590.e9.
Lopes JA, Jorge S, Resina C, Santos C, Pereira A, Neves J, et al. Acute renal failure in patients with sepsis. Crit Care 2007;11(2):411. DOI: 10.1186/cc5735.
Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, et al. Prognosis for long-term survival and renal recovery in critically-ill patients with severe acute renal failure: a population-based study. Crit Care 2005;9(6):R700–R709. DOI: 10.1186/cc3879.
Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 2001;29(10):1910–1915. DOI: 10.1097/00003246-200110000-00010.
Wan L, Bellomo R, Di Giantomasso D, Ronco C. The pathogenesis of septic acute renal failure. Curr Opin Crit Care 2003;9(6):496–502. DOI: 10.1097/00075198-200312000-00006.
Zarjou Abolfazl, Agarwal A. Sepsis and acute kidney. Injury J Am SocNephrol 2011;22(6):999–1006. DOI: 10.1681/ASN.2010050484.
Yegenaga I, Hoste E, Van Biesen W, Vanholder R, Benoit D, Kantarci G, et al. Clinical characteristics of patients developing ARF due to sepsis/systemic inflammatory response syndrome: results of a prospective study. Am J Kidney Dis 2004;43(5):817–824. DOI: 10.1053/j.ajkd.2003.12.045.
Kaul A, Sharma RK, Tripathi R, Suresh KJ, Bhatt S, Prasad N. Spectrum of communityacquired acute kidney injury in India: a retrospective study. Saudi J Kidney Dis Transpl 2012;23(3):619–628.
Eswarappa MS, Gireesh V, Ravi D, Kumar, Dev G. Spectrum of acute kidney injury in critically ill patients: a single center study from South India. Indian J Nephrol 2014;24(5):280–285. DOI: 10.4103/0971-4065.132991.
Shah PR, Gireesh MS, Kute VB, Vanikar AV, Gumber MR, Patel HV, et al. Renal involvement in sepsis: a prospective single center study of 136 cases. Saudi J Kidney Dis Transpl 2013;24(3):620–629. DOI: 10.4103/1319-2442.111089.
Prakash J, Murthy AS, Vohra R, Rajak M, Mathur SK. Acute renal failure in the intensive care unit. J Assoc Physicians India 2006;54:784–788.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11(2):R31. DOI: 10.1186/cc5713.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003;31(4):1250–1256. DOI: 10.1097/01.CCM.0000050454.01978.3B.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 1999;130(6):461–470. DOI: 10.7326/0003-4819-130-6-199903160-00002.
Suh SH, Kim CS, Choi JS, Bae EH, Ma SK, Kim SW. Acute kidney injury in patients with sepsis and septic shock: risk factors and clinical outcomes. Yonsei Med J 2013;54(4):965–972. DOI: 10.3349/ymj.2013.54.4.965.
Bagshaw SM, George C, Bellomo R. ANZICS database management committee. Early acute kidney injury and sepsis: a multi-centre evaluation. Crit Care 2008;12(2):R47. DOI: 10.1186/cc6863.
Plataki M, Kashani K, Cabello-Garza J, Maldonado F, Kashyap R, Kor DJ, et al. Predictors of acute kidney injury in septic shock patients: an observational cohort study. Clin J Am Soc Nephrol 2011;6(7): 1744–1751. DOI: 10.2215/CJN.05480610.
Oppert M, Engel C, Brunkhorst FM, Bogatsch H, Reinhart K, Frei U, et al. German competence network sepsis (Sepnet). Acute renal failure in patients with severe sepsis and septic shock - A significant independent risk factor for mortality: results from the German prevalence study. Nephrol Dial Transplant 2008;23(3):904–909. DOI: 10.1093/ndt/gfm610.
Singh TB, Rathore SS, Choudhury TA, Shukla VK, Singh DK, Prakash J. Hospitalacquired acute kidney injury in medical, surgical, and intensive care unit: a comparative study. Indian J Nephrol 2013;23(1):24–29. DOI: 10.4103/0971-4065.107192.