PREVALENCE AND ETIOLOGY OF ACUTE KIDNEY INJURY IN ICU PATIENTS

Dr. Harish Basera*

ABSTRACT

Throughout the world in ICUs, acute kidney injury (AKI) is becoming increasingly found. Admitted kidney patient develop significant complications and require ongoing adjustments in care, as seen in these reader questions. On the basis of Risk, Injury, Failure, Loss of kidney function, End-stage renal disease (RIFLE) criteria, the subsequent pediatric RIFLE (pRIFLE) score, and the Acute Kidney Injury Network (AKIN) criteria. Anatomically AKI is classified into three categories: pre-renal causes, renal causes and post renal causes. Acute kidney injury (AKI) is an abrupt and usually reversible decline in glomerular filtration rate (GFR). The detection, incidence rate in ICU, causes, diagnosis, and prevention of AKI are presented separately. Among hospitalized patients, AKI is most commonly due to either pre-renal etiologies or acute tubular necrosis (ATN) from ischemia, nephrotoxin exposure, or sepsis. Longer hospital stay and economic burden are inevitable. In contrast to western literature, few reliable statistics are available regarding AKI in India. Causes of AKI are frequently categorized as prerenal, intrinsic renal, and post-renal. This classification system oversimplifies the overlapping pathologic mechanisms underlying AKI. Material and Methods: AKI was classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria in three stages in this study we studied 270 patients in an ICU during a follow-up of period. The use of central venous and arterial blood pressure monitoring, urine analysis and microscopy allows assessment of fluid volume status and etiology of AKI. Data elements included: demographics, comorbid conditions, hospital and ICU admission and discharge data, blood and urine laboratory studies including microbiology, medication use, and the use of parenteral and enteral nutrition. The serum creatinine level increases by ≥ 0.35 mg/dl within 48 h or increase in serum creatinine to more than 1.5 times baseline within the previous 7 days. The urine volume contains < 0.5 ml/kg/h for 6 hours. Results: Mean age of the patients included in the study was 65.4 years. There were 168 (62.22%) male and 102 (37.78%) females. In 146 (54.07%) hypertension was the associated co-morbid condition. Diabetes was present in 164(60.74%) of the cases. 24 (8.89%) were having associated liver disease. 6 (2.22%0 were HIV (Human Immunodeficiency virus) positive. 49 (18.15) were having COPD (Chronic Obstructive Pulmonary Disease) as a comorbid condition. The overall in-hospital mortality rate was 19.63 % (53/270). The 28-day mortality rate was 7.78 % (21/270) and the ICU mortality rate was 9.63% (26/270). About 124 (45.93%) patients with AKI required dialysis in the ICU. Conclusion: Sepsis was the most common cause of AKI in the critically ill patients of our study. Age >60, male gender were prevalent in the majority of AKI patients. More than 60% of the patients had associated comorbidities, with type 2 diabetes, hypertension and coronary artery disease being the three most common. About, 60% of the total patients recovered normal renal function, with 2.4% of the total patients developing CKD. Crude mortality rate among patients with AKI in our study group was 37.04%.

Keywords: ICUs, AKI, GFR, ARF, AKIN, RIFLE, AKI.