#5020 HETEROGENEITY OF HOSPITAL AQUIRED ACUTE KIDNEY INJURY AND THE IMPORTANCE OF EARLY VERSUS LATE NEPHROLOGY ASSESSMENT: A RETROSPECTIVE STUDY OF ONE CENTER

Abstract

Abstract Background and Aims Acute Kidney injury (AKI) is a serious disease with a significant social and economic burden worldwide. The epidemiology of AKI is not well defined, nevertheless the incidence of AKI in hospitalized patients is deemed to be 10- 15%. AKI is a syndrome provoked from various clinical conditions and has different management depending on the cause, the stage and the comorbidities of the patients. The aim of this study is to describe the heterogeneity of hospital acquired AKI as it concerns the underlying cause and the applied treatment as well as to emphasize on the high importance of the time of nephrology assessment Method This is a retrospective observational single-center study, including 1082 adult patients with hospital acquired AKI according to the KDIGO guidelines, hospitalized in different departments of our hospital from January 2021 to September 2022. Patients with End Stage Renal Disease were excluded from this study. Results A total of 1082 adult patients were recorded with median age 77 years. The majority of them had several comorbidities, 457(42%) diabetic, 424(39%) hypertensive and 442(41%) with Chronic Kidney Disease (CKD). Principal causes of AKI were cardiovascular disease (405;38%), infection (198;18%), gastrointestinal disorders (130;12%) and malignancy (103;10%). Other etiologies comprise obstructive nephropathy (45;4%), bleeding (36;3%), surgery (29;3%), cardiovascular surgery (13;1%) and miscellaneous (123;12). Management of AKI included fluid resuscitation applied in 405;37% cases, intravenous diuretic therapy applied in 241;22% patients, while 216;20% cases required hemodialysis. The mean creatinine value at assessment was 3.9±2 mg/dl while 15% of the patients had a normal admission creatinine (<1.3mg/dl). The patients were classified in three groups according to the creatine levels rise: A) 345 patients at baseline had a creatinine rise of 0.3-0.5 mg/dl, B) 343 had a rise of 0.6-1 mg/dl and C) 394 had a rise of type="Periodical" type="Periodical">1 mg/dl. The mean value of hospitalization days for each of the 3 above groups was calculated as 10.8 ± 10.3, 10.7 ± 8.1 and 14.7 ± 11.4 respectively, p<0.05 for the comparisons with the 3rd group. In comparison, there was no significant difference in the treatment method of AKI between the first 2 groups, but Hemodialysis was applied more frequent in the 3rd group (44 vs 46 vs 124 patients, p<0.05 for the comparisons with the 3rd group). Regarding the difference between the creatinine levels on admission and the creatinine levels on discharge, a statistically significant difference was found between the 3 groups (p<0.05) with prevalence of worst discharge creatine levels to the third group. 15% exited with creatinine <1.3 mg/dl. In a multivariate linear regression model, it was also found that for the difference in admission-discharge creatinine levels, diabetes mellitus was an independent factor (p = 0.035) as well as the group categorized based on the increase in creatinine during assessment (p<0.01). Conclusion Hospitalized patients in non-nephrology clinics may develop AKI and require different treatment plan as well as management of the primary cause. The heterogeneity of AKI and the need for dialysis as well as the days of hospitalization, underlines the need for close observation, personalized care, vigilance of other specialists and the cooperation with nephrologists. As it is shown from this study the early nephrology assessment is associated with fewer days of hospitalization and better outcome for the patient's renal function, as well as the severity of the treatment. As the prevalence of chronic kidney disease is rising around the world is of great importance for the patients with AKI to be able to maintain their kidney function.