Clinical profile of patients with acute kidney injury admitted in intensive care unit
Keywords:Acute kidney injury, Etiology, Intensive care unit, Mortality, Sepsis
Background: Acute kidney injury (AKI) is a frequent complication in critically sick patients admitted to the intensive care unit (ICU). The objective of this study was to assess the risk factors and clinical outcomes of AKI in patients admitted to a teaching hospital's intensive care unit.
Methods: This prospective observational study was conducted in the department of internal medicine, Janaki Medical College, Janakpur, Nepal from June 2018 till May 2019. Adults (aged 18 years or more) diagnosed with AKI using RIFLE criteria and were either admitted in ICU with diagnosis of AKI or developed AKI after admission to ICU. AKI patients were classified as those who satisfied any of the RIFLE categorization criteria.
Results: The most common presenting complaint was fever (77%). The most common etiology of AKI was sepsis (71%). Other causes of AKI were post-operative cases (16%) and alcoholic liver disease (13%). When classified as per RIFLE criteria, we classified 38 cases (31.9%) as ‘risk’, 53 (44.54%) as ‘injury’ and 28 (23.53%) as ‘failure’. The etiological classification of our patients to be significantly associated with RIFLE classification (p<0.01). However, we found the mortality not to be significantly associated with RIFLE classification (p=0.74).
Conclusions: AKI classification should be used as a risk assessment tool towards the AKI's influence on the prognosis of ICU patients. Further study should investigate determining the death rate according to the RIFLE criteria in this region of Nepal.
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(4):1613-21.
Chawla LS, Abell L, Mazhari R, Egan M, Kadambi N, Burke HB, et al. Identifying critically ill patients at high risk for developing acute renal failure: a pilot study. Kidney Int. 2005;68(5):2274-80.
Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committe. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23(5):1569-74.
Bhattacharjee K, Thakur CP, Das D. Spectrum of acute kidney injury in critically ill patients in medical ICU: A single center hospital-based study from North-Eastern India. JEBMH 2018;5:893-97.
Eswarappa M, Gireesh MS, Ravi V, Kumar D, Dev G. Spectrum of acute kidney injury in critically ill patients: A single center study from South India. Indian J Nephrol. 2014;24(5):280-5.
Korula S, Balakrishnan S, Sundar S, Paul V, Balagopal A. Acute kidney injury-incidence, prognostic factors, and outcome of patients in an Intensive Care Unit in a tertiary center: A prospective observational study. Indian J Crit Care Med. 2016;20(6):332-6.
Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35(10):1692-702.
Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007;18(4):1292-8.
Mahmood N, Rahman MF, Rahman MM, Shahid SH, Siddiqui MM. Acute kidney injury in patients of intensive care unit. Anwer Khan Modern Med College J. 2017;8(1):38-44.
Ratanarat R, Hantaweepant C, Tangkawattanakul N, Permpikul C. The clinical outcome of acute kidney injury in critically ill Thai patients stratified with RIFLE classification. J Med Assoc Thai 2009;92(2):61‐7.