Citation Information :
Soni KD, Singh A, Tyagi A, Singh Y, Aggarwal R, Trikha A. Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case–Control Study. Indian J Crit Care Med 2023; 27 (1):22-25.
Background: Acute kidney injury (AKI) following severe trauma is common. However, the requirement of renal replacement therapy (RRT) in these patients is rare and is associated with high morbidity and mortality. The primary objective of this study was to identify odds of risk factors, in particular, hypotension at presentation, for the requirement of RRT in patients with AKI following trauma.
Methods: We performed a case–control study involving patients who were admitted to the intensive care unit (ICU) at a level I trauma center for at least 24 hours. The primary outcome measure was a study of the odds of risk factors associated with the requirement of RRT in such patients. Univariate comparisons and multiple logistic regression analyses were done to identify other risk factors.
Results: The presence of crush injury, sepsis, and elevated serum creatinine (sCr) on arrival were identified to be independent risk factors for RRT requirement. Hypotension and exposure to radiocontrast or nephrotoxic antimicrobials were not found to be associated with the need for RRT. Acute kidney injury requiring RRT was associated with significantly increased ICU length of stay (15 days vs 5 days; p < 0.001) and higher mortality (83% vs 35%; p < 0.001).
Conclusion: The presence of crush injury, sepsis, and elevated sCr on presentation were identified to be independent risk factors while hypotension association was insignificant for AKI requiring RRT in our investigation.
World Health Organization. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence. Accessed on: 23 December 2022.
Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: Are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma 2010;69(3):620–626. DOI: 10.1097/TA.0b013e3181bbfe2a.
Harrois A, Libert N, Duranteau J. Acute kidney injury in trauma patients. Curr Opin Crit Care 2017; 23(6):447–456. DOI: 10.1097/MCC.0000000000000463.
Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: The multinational AKI–EPI study. Intensive Care Med 2015;41(8):1411–1423. DOI: 10.1007/s00134-015-3934-7.
Søvik S, Isachsen MS, Nordhuus KM, Tveiten CK, Eken T, Sunde K, et al. Acute kidney injury in trauma patients admitted to the ICU: A systematic review and meta-analysis. Intensive Care Med 2019;45(4):407–419. DOI: 10.1007/s00134-019-05535-y.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. (2007) 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.
KIDIGO. Kidney Disease: Improving Global Outcomes KDIGO Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1–138. Available at: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf.
Fujinaga J, Kuriyama A, Shimada N. Incidence and risk factors of acute kidney injury in the Japanese trauma population: A prospective cohort study. Injury 2017;48(10):2145–2149. DOI: 10.1016/j.injury.2017.08.022.
Brandt MM, Falvo AJ, Rubinfeld IS, Blyden D, Durrani NK, Horst HM. Renal dysfunction in trauma: Even a little costs a lot. J Trauma 2007;62(6):1362–1364. DOI: 10.1097/TA.0b013e318047983d.
Bagshaw SM, George C, Gibney RT, Bellomo R. A multicenter evaluation of early acute kidney injury in critically ill trauma patients. Ren Fail 2008;30(6):581–589. DOI: 10.1080/08860220802134649.
Gomes E, Antunes R, Dias C, Araújo R, Costa–Pereira A. Acute kidney injury in severe trauma assessed by RIFLE criteria: A common feature without implications on mortality? Scand J Trauma Resusc Emerg Med 2010;18:1. DOI: 10.1186/1757-7241-18-1.
Bihorac A, Delano MJ, Schold JD, Lopez MC, Nathens AB, Maier RV, et al. Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients. Ann Surg 2010;252(1):158–165. DOI: 10.1097/SLA.0b013e3181deb6bc.
Beitland S, Moen H, Os I. Acute kidney injury with renal replacement therapy in trauma patients. Acta Anaesthesiologica Scandinavica 2010;54(7):833–840. DOI: 10.1111/j.1399-6576.2010.02253.x.
Shashaty MG, Meyer NJ, Localio AR, Gallop R, Bellamy SL, Holena DN, et al. African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients. J Crit Care 2012;27(5):496–504. DOI: 10.1016/j.jcrc.2012.02.002.
Podoll AS, Kozar R, Holcomb JB, Finkel KW. Incidence and outcome of early acute kidney injury in critically-ill trauma patients. PLoS One 2013;8(10):e77376. DOI: 10.1371/journal.pone.0077376.
Skinner DL, Hardcastle TC, Rodseth RN, Muckart DJJ. The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit. Injury 2014;45(1):259–264. DOI: 10.1016/j.injury.2013.07.013.
Eriksson M, Brattstrom O, Martensson J, Larsson E, Oldner A. Acute kidney injury following severe trauma: Risk factors and long-term outcome. J Trauma Acute Care Surg 2015;79(3):407–412. DOI: 10.1097/TA.0000000000000727.
Vivino G, Antonelli M, Moro ML, et al. Risk factors for acute renal failure in trauma patients. Intensive Care Med 1998;24(8):808–814. DOI: 10.1007/s001340050670.
Stewart IJ, Sosnov JA, Howard JT, Chung KK. Acute kidney injury in critically injured combat veterans: A retrospective cohort study. Am J Kidney Dis 2016;68(4):564–570. DOI: 10.1053/j.ajkd.2016.03.419.
Stewart IJ, Faulk TI, Sosnov JA, Clemens MS, Elterman J, Ross JD, et al. Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality. J Trauma Acute Care Surg 2016;80(3):492–498. DOI: 10.1097/TA.0000000000000933.
Raju NA, Rao SV, Joel JC, Jacob GG, Anil AK, Gowri SM, et al. Predictive value of serum myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis. Indian J Crit Care Med 2017;21(12):852–856. DOI: 10.4103/ijccm.IJCCM_186_17.
Haines RW, Lin S-P, Hewson R, Kirwan CJ, Torrance HD, O'Dwyer, et al. Acute kidney injury in trauma patients admitted to critical care: Development and validation of a diagnostic prediction model. Sci Rep 2018;8(1):3665. DOI: 10.1038/s41598-018-21929-2.
Gaudry S, Hajage D, Schortgen F, Martin–Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med 2016;375(2):122–133. DOI: 10.1056/NEJMoa1603017.