Citation Information :
Saxena A, Meshram S. Predictors of mortality in acute kidney injury patients admitted to medicine intensive care unit in a Rural Tertiary Care Hospital. Indian J Crit Care Med 2018; 22 (4):231-237.
Background: Acute kidney injury (AKI) is a challenging problem faced by intensive care clinicians worldwide, and it is associated with high morbidity and mortality, especially in critically ill patients.
Materials and Methods: A hospital-based prospective, observational study was conducted in patients of AKI admitted to the Intensive Care Unit (ICU) of the Department of Medicine in a rural tertiary care hospital located in central India. Data of all consecutive AKI inpatients related to demographic variables, clinical profile, and laboratory investigations were collected from patient\'s medical records.
Results: Of the total 229 AKI patients enrolled in this study, 65 (28.4%) patients died during their hospital stay. The presence of metabolic acidosis, hypotension, Glasgow coma scale (GCS) and Acute Physiologic Assesment and Chronic Health Evaluation (APACHE 2) score, advanced AKI stage, higher serum creatinine and blood urea levels on diagnosis of AKI and the peak rise in their level within 48 h of diagnosis of AKI, the use of mechanical ventilator, leukocytosis, and hyperkalemia were significantly associated with in-hospital mortality in AKI patients (P < 0.05).
Conclusion: The overall in-hospital mortality in patients of AKI admitted to medicine-ICU was 28.4%. Sepsis was the most common cause of AKI (24.5%). The presence of metabolic acidosis, hypotension, GCS and APACHE 2 score, advanced AKI stage, higher serum creatinine, and blood urea levels on diagnosis of AKI and the peak rise in their level within 48 h of diagnosis of AKI, use of mechanical ventilator, leukocytosis, and hyperkalemia were associated with in-hospital mortality in AKI patients.
Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet 2005;365:417-30.
Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996;334:1448-60.
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.
Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: An increasing global concern. Lancet 2013;382:170-9.
Cerdá J, Lameire N, Eggers P, Pannu N, Uchino S, Wang H, et al. Epidemiology of acute kidney injury. Clin J Am Soc Nephrol 2008;3:881-6.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16:3365-70.
Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: A national survey. Clin J Am Soc Nephrol 2006;1:43-51.
Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: A systematic review and meta-analysis. Kidney Int 2012;81:442-8.
Schiffl H, Lang SM, Fischer R. Long-term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: A 10-year prospective cohort study. Clin Kidney J 2012;5:297-302.
Rifkin DE, Coca SG, Kalantar-Zadeh K. Does AKI truly lead to CKD? J Am Soc Nephrol 2012;23:979-84.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120:c179-84.
Peres LA, Wandeur V, Matsuo T. Predictors of acute kidney injury and mortality in an Intensive Care Unit. J Bras Nefrol 2015;37:38-46.
Oluseyi A, Ayodeji A, Ayodeji F. Aetiologies and short-term outcomes of acute kidney injury in a tertiary centre in Southwest Nigeria. Ethiop J Health Sci 2016;26:37-44.
Hamzić-Mehmedbašić A, Rašić S, Balavac M, Rebić D, Delić-Šarac M, Durak-Nalbantić A, et al. Prognostic indicators of adverse renal outcome and death in acute kidney injury hospital survivors. J Renal Inj Prev 2016;5:61-8.
Poukkanen M, Vaara ST, Reinikainen M, Selander T, Nisula S, Karlsson S, et al. Predicting one-year mortality of critically ill patients with early acute kidney injury: Data from the prospective multicenter FINNAKI study. Crit Care 2015;19:125.
Kohli HS, Bhat A, Jairam A, Aravindan AN, Sud K, Jha V, et al. Predictors of mortality in acute renal failure in a developing country: A prospective study. Ren Fail 2007;29:463-9.
Shiao CC, Ko WJ, Wu VC, Huang TM, Lai CF, Lin YF, et al. U-curve association between timing of renal replacement therapy initiation and in-hospital mortality in postoperative acute kidney injury. PLoS One 2012;7:e42952.
Sezer MT, Demir M, Gungor G, Senol A. Predictors of mortality in patients with acute renal failure. Acta Medica (Hradec Kralove) 2006;49:183-8.
Samimagham HR, Kheirkhah S, Haghighi A, Najmi Z. Acute kidney injury in Intensive Care Unit: Incidence, risk factors and mortality rate. Saudi J Kidney Dis Transpl 2011;22:464-70.
Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM. The outcome of acute renal failure in the Intensive Care Unit according to RIFLE: Model application, sensitivity, and predictability. Am J Kidney Dis 2005;46:1038-48.
Ostermann M, Chang RW. Acute kidney injury in the Intensive Care Unit according to RIFLE. Crit Care Med 2007;35:1837-43.
Krishnamurthy S, Narayanan P, Prabha S, Mondal N, Mahadevan S, Biswal N, et al. Clinical profile of acute kidney injury in a pediatric Intensive Care Unit from Southern India: A prospective observational study. Indian J Crit Care Med 2013;17:207-13.
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.
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.
Kaul A, Sharma RK, Tripathi R, Suresh KJ, Bhatt S, Prasad N, et al. Spectrum of community-acquired acute kidney injury in India: A retrospective study. Saudi J Kidney Dis Transpl 2012;23:619-28.
Pan HC, Jenq CC, Tsai MH, Fan PC, Chang CH, Chang MY, et al. Risk models and scoring systems for predicting the prognosis in critically ill cirrhotic patients with acute kidney injury: A prospective validation study. PLoS One 2012;7:e51094.
Lin CY, Chang CH, Fan PC, Tian YC, Chang MY, Jenq CC, et al. Serum interleukin-18 at commencement of renal replacement therapy predicts short-term prognosis in critically ill patients with acute kidney injury. PLoS One 2013;8:e66028.
Friedericksen DV, van der Merwe L, Hattingh TL, Nel DG, Moosa MR. Acute renal failure in the medical ICU still predictive of high mortality. S Afr Med J 2009;99:873-5.
Chertow GM, Soroko SH, Paganini EP, Cho KC, Himmelfarb J, Ikizler TA, et al. Mortality after acute renal failure: Models for prognostic stratification and risk adjustment. Kidney Int 2006;70:1120-6.
Wilson FP, Yang W, Feldman HI. Predictors of death and dialysis in severe AKI: The UPHS-AKI cohort. Clin J Am Soc Nephrol 2013;8:527-37.
Dela Cruz CM, Pineda L, Rogelio G, Alano F. Clinical profile and factors affecting mortality in acute renal failure. Ren Fail 1992;14:161-8.
Obialo CI, Okonofua EC, Nzerue MC, Tayade AS, Riley LJ. Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure. Kidney Int 1999;56:1058-63.
Teixeira C, Garzotto F, Piccinni P, Brienza N, Iannuzzi M, Gramaticopolo S, et al. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care 2013;17:R14.
de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000;26:915-21.