Investigation of acute kidney injury and related factors in hospital patients; single center experience (original) (raw)
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STUDY OF ACUTE KIDNEY INJURY IN PATIENTS ADMITTED IN INTENSIVE CARE UNIT IN TERTIARY CARE HOSPITAL
public health problem worldwide affecting millions of patients leading to decreased survival. AKI complicates 5–7% of acute care hospital admissions and up to 30% of admissions to the intensive care unit. AKI is a common complication of ICU and also associated with a markedly increased risk of death in hospitalized individuals, particularly in those admitted to the ICU where in-hospital mortality rates may exceed 50% when Compared to western literature, reports from our country are limited and hence there is a need to understand the clinical profile of these patients here. A thorough understanding of clinical spectrum of disease is needed in order to devise methods to improve final outcome due to AKI in ICU admitted cases. The present study aims to know the clinical spectrum of AKI in patients admitted in intensive care unit and to determine the risk, prognostic factors and final outcome of AKI patients who are admitted in intensive care unit tertiary care hospitals in Bangalore city. A total 100 patients of AKI patients admitted in ICU were considered for the study. The data was collected through a pretested proforma, which included various like patients history, Clinical examination, Diagnosis, Laboratory parameters, Urine output, Comorbid conditions, dialysis, MSOF etc., The Patients were followed up till the event of discharge or death in hospital. The main outcome evaluated was mortality. As per the analysis present study demonstrates majority of patients were in 51 to 60 years age group (24%) with highest mortality in 51 to 60 age group (32.1%). Fever was the most common presentation of patients (46%); Sepsis was the most common diagnosis (59%). Oliguric renal failure was seen in 49% cases. Comorbidity was seen in 51% of the patients; hypertension (30 cases), diabetes mellitus (23 cases), COPD (11 cases) and IHD (7 cases). A high overall mortality of 56% was seen which is consistent with other studies done in various parts of the world. Intrinsic type of renal failure was the most common type (68%). MSOF was noted in 63% of the patients. 37% of the patients required ventilator support and 45 % patients required dialysis. Mortality increased in older age group, comorbid conditions, oliguric renal failure. Sepsis was the most common cause. Intrinsic type of renal failure was the most common type of AKI seen. There was an increased mortality seen in patients who required dialysis, and mechanical ventilation. Presence of MSOF was associated with poor prognosis.
Acute Kidney Injury in Patients of Intensive Care Unit
Anwer Khan Modern Medical College Journal, 2017
Background: Acute Kidney Injury (AKI) is a common complication in patients admitted to the intensive care unit (ICU) and numerous causes are responsible for its development. The aim of the present study is to assess the incidence, risk factors, and outcome of patients who develop AKI in our ICU. Methodology: This study was conducted by the Department of Nephrology, Anwer Khan Modern Medical College Hospital (AKMMCH), a tertiary level center of Dhaka, during the period of January 2015 to December 2015. This is a Cross Sectional Descriptive type of Observational study on patients of Acute Kidney Injury (AKI) admitted to Intensive Care Unit (ICU) of AKMMCH. Result: A total number of 271 patients were admitted. Out of 271 patients, 59 (21.77%) patients with AKI who met our study requirements were included in the study and were evaluated. Among 59 patients 32 (54.23%) were males and 27 (45.77%) were females, with a male to female ratio of 1.19:1. The cause of admission were Diabetes mellitus with complication 11 (18.64%), Hepato-renal syndrome 10 (16.94%), Malignancy 7 (11.86%), Septicaemia 6 (10.18%), Pneumonia 6 (10.18%), Intra-uterine death (IUD) 5 (8.48%) and others (Acute Myocardial Infarction, Non ST segment Elevated MI, Cerebro Vascular Disease, Gullain Burre Syndrome, Laparatomy, Type I and Type II Respiratory failure) 14 (23.72%). According to RIFLE's criteria most of the patients were from Injury group 32 (54.23%). Next to this, was Risk group 17 (28.83%) and in Failure, Loss and ESRD group were 7 (11.86%), 1(1.69%) and 2 (3.39%) accordingly. Regarding biochemical abnormality, mean Serum creatinine was 3.68 ± 2.15 and that of Urine output, HbA1C and HCO3 level (in ABG) were 4.57 ± 8.89, 6.91±1.4 and 17.14 ± 3.8 respectively. Out of 59 patients 10 (16.95%) needed Haemodialysis. According to RIFLE's criteria 7 (70%) were from Failure group, 1 patient from Loss group and 2 from ESRD group who received haemodialysis. 72.88% (43) patients improved, out of which 57.62% (34) got discharged from ICU after full recovery. 6.48% (4) patients expired and 3.38% (2) turned into ESRD and advised for regular haemodialysis. Conclusion: The incidence of AKI is high in patients admitted to ICU, and the development of AKI is associated with poor outcome and reduced survival. AKI significantly increases the duration of ICU stay, and this is likely to add to the healthcare burden. Age, gender or the presence of comorbidities do not appear to influence the incidence of AKI in our ICU patients.
Bangladesh Critical Care Journal, 2019
Acute Kidney Injury (AKI) is a common cause of morbidity and mortality worldwide. However it is a treatablecondition. Any disease when associated with AKI, mortality and morbidity increase manifolds.1 Early diagnosis andtreatment is important to reduce morbidity, mortality and ICU admission. Causes of AKI may vary in country to countryeven within the country. International society of Nephrology has set a high ambitious goal “0 by 25” targeting zerodeath due to untreated AKI by 2025. Heading this challenge, it is important to know the causes of AKI worldwide.However, most of the AKI studies have been done in the developed countries and limited information is availableregarding Asia, Africa and south America. Inspired by this slogan, this study was directed to find out the causes of AKIin admitted patients in United Hospital Limited between July 2015 to February 2017. Total 98 patients were includedin the study. In our study, Infection and cardio-renal syndrome were the leading causes...
Hospital-acquired acute kidney injury in Israel
The Israel Medical Association journal : IMAJ, 2009
Acute kidney injury remains a common significant clinical problem. Yet there are scant data in Israel on the incidence of hospital-acquired AKI and on diagnosis validity. To describe the epidemiology of AKI among hospitalized patients in the Western Galilee Hospital, Nahariya, compare discharge summaries to laboratory diagnosis, and investigate the impact of AKI on mortality and length of stay. Computerized medical and laboratory data of 34,802 hospitalized subjects were collected. AKI was diagnosed according to three different definitions. We calculated the sensitivity and specificity of AKI based on ICD-9 diagnosis compared to patient's laboratory data as the gold standard. The overall AKI annual incidence rate was 1-5.1%, depending on the AKI definition used. The incidence of AKI based on ICD-9 diagnosis was significantly lower compared to the laboratory-based diagnosis. Average in-hospital length of stay was 2.4 times longer among patients with AKI compared to subjects witho...
Incidence Epidemiology Acute Kidney Injury Tertiary Care Centre
SSR Institute of International Journal of Life Sciences, 2019
Background: Acute kidney injury (AKI) is a commonly encountered syndrome associated with various aetiologies and pathophysiological processes leading to decreased kidney function. This study was designed to assess the incidence and epidemiology of AKI of patients in a tertiary care centre in the Intensive Care Unit (ICU) of Gwalior, Madhya Pradesh, India. Methods: This was a prospective study of AKI patients, admitted in the Intensive Care Unit (ICU) of the Department of Medicine from September 2017 to February 2018. In total 100 AKI patients, which included 54 males and 46 females, male (44.20±8.54) and females (47.56±10.20) were collected and then subjected to the classification and arrangements data on the basis of general characteristics of patients; nature of disease and etiology of AKI amongst patients reported. Statistical data were collected using a self-administered questionnaire. Results: Total of 100 AKI patients with the mean age of male (44.20±8.54) and female (47.56±10.2) found. Cases of AKI causes were characteristics of AKI patients most prominent of co-mortality diabetic (18%) then hypertension (12%). Etiology of cases among the pneumonia was (13%), pylonephritis/ urosepsis (11%), acute gastrointestinal tract pathology (8%), meningitis (5%), bacterial gastroenteritis (5%), soft tissue injury (4%), and septic arthritis (3%) found. Female was risked to AKI majorly due to acute gastrointestinal tract pathology (8%). Hair dye (4%) was the first major poisonous cause of occurrence of AKI, followed by Organophosphorous (1%), celphos (3%), Datura (1%), and rat killer (1%). Conclusion: AKI was an increasing concern and potentially catastrophic complication in hospitalized patients and frequently observed in our study due to sepsis post-trauma and heart failure as well as it carries a poor prognosis.
"Etiology of Acute Kidney Injury in a Tertiary Care Hospital"
IOSR Journals , 2019
Acute kidney injury is one of the significant causes of morbidity and mortality world wide. The present study was done in a tertiary care hospital in East Godavari District , Andhra Pradesh, India, among 100 patients of acute kidney injury with an objective to find out the most common causes of AKI in this particular area. Results showed that the major causes of AKI in this area are sepsis, gastroenteritis, heart failure and malaria.
Epidemiology of Acute Kidney Injury (AKI) among Hospitalized.pdf
Background: Acute kidney injury (AKI) is a syndrome characterized by decreased glomerular filtration. The spectrum of AKI ranges from minimal elevations in serum creatinine (SCr) to complete anuric kidney failure. Despite ample knowledge of the biologic basis of AKI, descriptions of the incidence, risk factors, sequelae, and outcomes of AKI remain relatively limited or have been based upon older descriptions without reflecting the most current definitions or practice patterns.
Acute Kidney Injury: Its Etiological Factors, Co-Morbidities and Mortality Risk
2020
AKI (Acute Kidney Injury) constitutes approximately 5-7% of hospital admissions and up to 30% of admissions to intensive care units. Large referrals to dialysis units suggest that the condition is more common in Pakistan. The study was conducted to identify the etiological factors, co-morbidities and mortality risk in AKI.
SBMU publishing, 2018
Introduction: Elimination of preventable deaths due to acute kidney injury (AKI) in low-income countries by 2025 is an important healthcare goal at the international level. The present study was designed with the aim of evaluating the prevalence and outcome of AKI in patients presenting to emergency department. Methods: The present cross-sectional, retrospective study was performed on patients that presented to the emergency departments of 3 major teaching hospitals, Tehran, Iran, between 2005 and 2015 and were diagnosed with AKI. Patient selection was done using consecutive sampling and required data for this study was extracted by referring to the medical profiles of the patients and filling out a checklist designed for the study. Results: 770 AKI patients with the mean age of 62.72 ± 19.79 (1 – 99) years were evaluation (59.1% male). 690 (89.61%) cases of AKI causes were pre-renal or renal. Among the pre-renal causes, 74 (73.3%) cases were due to different types of shock (p < 0.001). The most common etiologic causes of AKI in pre-renal group were hypotension (57.3%) and renal vascular in-sufficiency (31.6%). In addition, regarding the renal types, rhabdomyolysis (35.0%), medication (17.5%) and chemotherapy (15.3%) and in post-renal types, kidney stone (34.5%) were the most common etiologic causes. 327 (42.5%) patients needed dialysis and 169 (21.9%) patients died. Sex (p = 0.001), age over 60 years (p = 0.001), blood urea nitrogen level (p < 0.001), hyperkalemia (p < 0.001), metabolic acidosis (p < 0.001), cause of failure (p = 0.001), and type of failure (p = 0.009) were independent risk factors of mortality. Conclusion: The total prevalence of AKI in emergency department was 315 for each 1000000 population and preventable mortality rate due to AKI was estimated to be 28.2 cases in each 1000000 population. The most important preventable AKI causes in the pre-renal group included shock, sepsis, and dehydration; in the renal group they included rhabdomyolysis and intoxication; and stones in the post-renal group.
Background : The burden of Acute Kidney injury in developing countries especially in Sub-Saharan Africa is enormous. The morbidity and mortality appears to be rising despite the availability of dialysis therapy in some parts of Africa. Objective: To determine the causes and the factors that influence outcome of acute kidney injury in hospitalized patients at the Design : This was a prospective study of patients with acute kidney injury admitted in UCTH, Calabar over a 12 month period from January 2014 to December 2014. Data was analysed using SPSS version 18. Results : A total of 1138 patients were admitted with 42 of them developing AKI giving an incidence rate of 3.6%. Eighteen (42.9%) of the participants were males while 24 (57.1%) were females. Age ranged from 11 to 81 years with a mean age of 44.2±17.32 years. The common causes of AKI were septicaemia 20 (47.6%), malignant phase hypertension 7 (16.7%) and hypovolaemia 4 (9.5%).Other causes accounted for the remaining 11 (26.1%). Thirty one (73.8%) had co-morbidities and hypertension 12 (38.7%) was the commonest co-morbid condition. For outcome, 29 (69.0%) of the patients were discharged home while 13 (31.0%) of them died in the hospital. Survivors had more dialysis sessions than those that died (P < 0.05). Conclusion : Septicaemia is the commonest cause of AKI in our centre. In-hospital mortality rate is high. The severity of AKI at presentation and lack of dialysis therapy are contributory factors.