A STUDY OF ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT

Dr. Rahul, Dr. Jasmin Das

Abstract


Introduction: Acute kidney injury (AKI) is major global public health problem. AKI is defined as a functional or structural abnormality of the
kidney as determined by blood, urine or tissue tests or by imaging studies. AKI complicates upto 30% of admissions to intensive care units (ICU).
AKI is associated with very high rates of morbidity and mortality.
Materials and Methods: This is a prospective observational cohort study conducted in department of Nephrology in Christian Medical College
and Hospital, Ludhiana over a period of one year. Patients admitted in ICU fulfilling inclusion criteria were studied for the prevalence, risk factors,
etiology, outcomes of AKI and to compare for early diagnosis of AKI using RIFLE( risk, injury, failure, loss and end stage renal disease and AKIN (
acute kidney injury network) criteria. Independent unpaired t-test , Mann-Whitney U test and Chi-Square test were used for statistical analysis.
Results: A total of 360 patients were enrolled, 65.1% were male and 34.9% were females. The prevalence of AKI in ICU was 85.5% by AKIN and
80.7% by RIFLE criteria. Sepsis was the most common cause of AKI seen in 61.8% and 63.1% of patients by AKIN and RIFLE criteria. Mortality
was 22.3% and 23.2% by AKIN and RIFLE criteria respectively. RRT was required by 29.8% and 31.4% of AKI patients diagnosed by AKIN and
RIFLE criteria. Mortality rate of patients receiving RRT was 65.5%. Hypotension resulted in AKI in 56.3% and 58.4% of patients by AKIN and
RIFLE criteria and RRT was required in 39.4% and 40.3% of these patients respectively.
Conclusion: Prevalence of AKI in ICU is high. The AKIN criteria helps in early and more diagnosis of AKI compared to RIFLE criteria.
Hypotension and sepsis were the most common causes of AKI. Mortality was higher in AKI compared to non-AKI patients.


Keywords


Acute kidney injury, ICU, AKIN, RIFLE

Full Text:

PDF

References


Molitoris Bruce A.: Acute Kidney Injury: Goldman Lee, Schafer Andrew I., editors. Goldman’s Cecil Medicine, 24th ed. Philadelphia: Elsevier Saunders;2012.p756-760.

Waikar SS, Bonventre JV: Acute Kidney Injury: Longo, Fauci, Kasper, Hauser, Jameson, Loscalzo, editors: Harrison’s Principles of Internal Medicine, 18th ed, New York: Mc Graw-Hill; 2012. P2293-308.

Macedo E, Malhotra R, Claure-Del Granado R, Fedullo P, Mehta RL. Defining urine output criterion for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2011 Feb;26(2):509-15. doi: 10.1093/ndt/gfq332. Epub 2010 Jun 17.

Balbi AL, Gabriel DP, Barsante RC, Caramori JT, Martin LC, Barreti P. Assessment of mortality and specific index in acute renal failure. Rev Assoc Med Bras (1992). 2005 Nov-Dec;51(6):318-22. Epub 2006 Jan 18.

Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002 May;39(5):930-6.

Hoste EA, Kellum JA. Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care 2006; 12(6): 531–7.

Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol. 2007 May;2(3):431-9. Epub 2007 Mar 21.

Rodrigo Cartin-Ceba, Markos Kashiouris, Maria Plataki, Daryl J. Kor, Ognjen Gajic and Edward T. Casey, et a. Risk Factors for Development of Acute Kidney Injury in Critically Ill Patients: A Systematic Review and Meta-Analysis of Observational Studies. Clin J Am Soc Nephrol. 2007 May;2(3):418-25.Epub 2017 Mar 27.

Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006; 10(3): R73. Epub 2006 May 12.

Zvada J, Hoste E, Cartin Ceba R, Calzavacca P, Gajic O, Clermont G, et al. A comparison of three methods to estimate baseline creatinine for RIFLE classification. Nephrology, Dialysis, Transplantation. 2010;25(12):3911-8. doi: 10.1093/ndt/gfp766

Levey A, Stevens L, Schmid C, Zhang Y, Castro A, Feldman H, et al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine. 2009;150(9):604-12.

Bagshaw SM, Uchino S, Cruz D, Bellomo R, Morimatsu H, Morgera S, Schetz M et al. A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury. Nephrol Dial Transplant. 2009 Sep;24(9):2739-44. doi: 10.1093/ndt/gfp159. Epub 2009 Apr 6.

Singbartl K, Kellum JA. AKI in the ICU: Definition, epidemiology, risk stratification, and outcomes. Kidney Int. 2012 May;81(9):819-25. doi: 10.1038/ki.2011.339. Epub 2011 Oct 5.

Jha V, Malhotra H, Sakhuja V, Chugh K. Spectrum of Hospital-acquired Acute Renal Failure in the Developing Countries— Chandigarh Study. Q J Med. 1992 Jul;83(303):497-505.

Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009 Oct;35(10):1692-702. doi: 10.1007/s00134-009-1530-4. Epub 2009 Jun 23.


Refbacks

  • There are currently no refbacks.