A STUDY OF ACUTE KIDNEY INJURY IN CRITICALLY ILL MEDICAL AND SURGICAL PATIENTS IN BUNDELKHAND REGION

Dr. N.S. Sengar, Dr. Gopambuj Singh Rathod, Dr. Sudhir Kumar, Dr. Shyam Mohan Yadav, Dr. Mohd. Imran

Abstract


Introduction: Acute kidney injury (AKI), previously known as acute renal failure, is characterized by the sudden impairment of kidney function resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys. The acute kidney injury (AKI) incidence in ICU patients varies widely from 3% to 30%, with mortality ranging from 36% to 90%, depending on the type of ICU, study population, the period during which the study is conducted, and the criteria used to define AKI.The present study was undertaken to study the clinical profile of AKI prospectively in various medical and surgical intensive care units in our hospital—a tertiary care center in north India.

Aims and objectives:To assess the incidence of AKI among critically ill patients,determine the prevalence of AKI in Intensive Care Unit patients,characterize differences in etiology and severity of AKI and to determine the impact of AKI on patients outcomes alongwith a comparative study to know the epidemiological and clinical profiles of AKI in surgical & medical ICU units.

Materials and methods: The study included a total of 170 patients and was carried out in the Department of General Medicine, M.L.B. Medical College, Jhansi (U.P.) from March. 2018 to Oct. 2019.Patients with suspected Acute Kidney Injury (AKI) in Medical & Surgical ICU units,staying for a minimum of 48 hrs in ICU and with age more than 12 yrs were included in the study while those who remained in the ICU for less than 6 hrs,having preexisting end-stage kidney disease on chronic dialysis,with prior renal transplant and who already had developed CKD were excluded.

Results: A total of 45.29% patients of the total critically ill patients developed AKI in our study from AKIN criteria out of which most of the patients were from medical ICU where AKIN grade III was the most common grade of AKI.Age >60, male gender were prevalent in the majority of AKI patients and represented 31.17% and 71.43% population respectively. Male to female ratio was around 2.5:1.Sepsis was the most common cause of AKI in the critically ill patients of our study and it was found in 35.06% of the patients which was followed by Acute gastroenteritis and various types of Poisoning that constituted 18.18% of patients.Of the 77 patients developing AKI, 40(51.94%) were having qSOFA score between 0 to 1 while rest 37(48.06%) were having qSOFA score of 2-3.Crude mortality rate among patients with AKI in our study group was 36.36%%.Almost half of the patients having AKI (49.35%) were improved.Majority of the patients did not require RRT and were treated conservatively. 72.72% of the total patients with AKI didn’t require any RRT while it was given in 27.28% patients.the patients who received RRT were mostly from medical ICUs Among those who were put on RRT,57.14% expired while 23.81% patients improved.Anuria was the commonest factor warranting need of RRT and it was present in 90.48% of those patients while acidosis was present in 76.19% patients.



Keywords


Acute kidney injury, Critically ill patients, Renal replacement therapy.

Full Text:

PDF

References


Sushrut S. Waikar; Joseph V. Bonventre.334: Acute Kidney Injury

T. B. Singh, S. S. Rathore, T. A. Choudhury, V. K. Shukla,1 D. K. Singh,2 and J. Prakash.Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study.Indian J Nephrol. 2013 Jan-Feb; 23(1): 24–29.

Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units–causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996;24:192–8.

Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: A prospective study. Am J Med. 1983;74:243–8.

Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, et al. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): Targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol. 2007;2:418–25.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, et al. Cost and Morality Associated With Postoperative Acute Kidney Injury. Ann Surg. 2014

Bihorac A, Delano MJ, Schold JD, et al. Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients. Ann Surg. 2010;252:158–65.

Ansermino M, Hemsley C. Intensive care management and control of infection in burned patients. BMJ. 2004;329:220–3.

Robert W. Schrier, Wei Wang, Brian Poole, and Amit Mitra.Acute renal failure: definitions, diagnosis, pathogenesis, and therap.J Clin Invest. 2004 Jul 1; 114(1): 5–14.

Bagshaw SM, George C, Bellomo R ANZICS Database Management Committee. Early acute kidney injury and sepsis: A multicentre evaluation. Crit Care. 2008;12:R47.

Kellum JA, Bellomo R, Ronco C. Definition and classification of acute kidney injury. Nephron Clin Pract. 2008;109:c182–7.

Sakhuja V, Sud K. Acute renal failure in the tropics. Saudi J Kidney Dis Transpl. 1998;9:247–60.

Sakhuja V, Sud K. Acute renal failure in the tropics. Saudi J Kidney Dis Transpl. 1998;9:247–60.

Gurcharan Avasthi, M.D.,1 Jasvinder Singh Sandhu, D.M.,2,* and Kavita Mohindra, M.D.1.Acute Renal Failure in Medical and Surgical Intensive Care Units—A One Year Prospective Study.RENAL FAILURE Vol. 25, No. 1, pp. 105–113, 2003

Hoste EA1, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, Edipidis K, Forni LG, Gomersall CD, Govil D, Honoré PM, Joannes-Boyau O, Joannidis M, Korhonen AM, Lavrentieva A, Mehta RL, Palevsky P, Roessler E, Ronco C, Uchino S, Vazquez JA, Vidal Andrade E, Webb S, Kellum JA..Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study.Intensive Care Med. 2015 Aug;41(8):1411-23. doi: 10.1007/s00134-015-3934-7. Epub 2015 Jul 11.

Zhi DY, Lin J, Zhuang HZ, Dong L, Ji XJ, Guo DC, Yang XW, Liu S, Yue Z, Yu SJ, Duan ML. Acute Kidney Injury in Critically Ill Patients with Sepsis: Clinical Characteristics and Outcomes. J Invest Surg. 2019 Dec;32(8):689-696. doi: 10.1080/08941939.2018.1453891. Epub 2018 Apr 25. PubMed PMID: 29693474.

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;20:332-6.

Koeze et al.,. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrology (2017) 18:70

Rubina Naqvi.Acute kidney injury from different poisonous substances.World J Nephrol. 2017 May 6; 6(3): 162–167.

Ning Liu Zhongheng Zhang, Yucai Hong ,Bing Li.Protocol for a prospective observational study on the association of variables obtained by contrast-enhanced ultrasonography and sepsis-associated acute kidney injury.Article (PDF Available) in BMJ Open 9(7):e023981 • July 2019

Tal Mandelbaum, MD,1,2 Daniel J Scott, PhD,2 Joon Lee, PhD,2 Roger G. Mark, MD PhD,2 Atul Malhotra, MD,3 Sushrut S. Waikar, MD MPH,4 Michael D. Howell, MD MPH,5 and Daniel Talmor, MD MPH1.Outcome of Critically ill Patients with Acute Kidney Injury using the AKIN Criteria.Crit Care Med. Author manuscript; available in PMC 2012 Dec 1.

P. S. Priyamvada, R. Jayasurya, Vijay Shankar, and S. Parameswaran.Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill: Experience from a Tertiary Care Center.Indian J Nephrol. 2018 Nov-Dec; 28(6): 413–420.

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 Oct;35(10):1692-702. doi: 10.1007/s00134-009-1530-4. Epub 2009 Jun 23. PubMed PMID: 19547955.

Wiedermann CJ, Wiedermann W, Joannidis M. Causal relationship between hypoalbuminemia and acute kidney injury. World J Nephrol. 2017 Jul 6;6(4):176-187. doi: 10.5527/wjn.v6.i4.176. Review. PubMed PMID: 28729966; PubMed Central PMCID: PMC5500455.

Daniele Roberto Giacobbe.Hypoalbuminemia as a predictor of acute kidney injury during colistin treatment.Article Open Access Published: 10 August 2018.

Mahajan S, Tiwari S, Bharani R, Bhowmik D, Ravi S, Agarwal SK, et al. Spectrum of acute renal failure and factors predicting its outcome in an intensive care unit in India. Ren Fail. 2006;28:119–24.

Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med. 1995;155:1505–11.


Refbacks

  • There are currently no refbacks.