Abstract
Background and Objectives
 Data on the etiology, management practices and outcome in patients admitted to intensive care units in Kerala has not been studied in depth. The etiology and patterns of AKI, as well as management practices are likely to differ in countries with resource limitations and variations in disease patterns. The present study was undertaken to identify the etiologic factors and outcome of patients with Acute Kidney Injury admitted in Medical ICU.
 Methods
 The study is a cross sectional study, done in 150 consecutive patients admitted to Medical Intensive Care Unit, Government Medical College, Kottayam meeting the AKIN creatinine criteria for acute kidney injury over a period of 12 months.
 Results and Discussion
 The most common diagnosis in the patients admitted with AKI in MICU was Leptospirosis (22%) followed by undifferentiated fever (21%) and sepsis seen in 17%. Dialysis was required in 81.3% among those with undifferentiated febrile illness and 78.8% among those with leptospirosis. Significant association was identified between etiology of AKI and the need for dialysis. The most common stage of AKI in the patients in this study group on admission to the medical intensive care unit was stage 3 in 64.7%. 45% of the patients required dialysis, among which 24% underwent CRRT while the 76% underwent hemodialysis.
 Out of 150 cases 59% survived and 41% expired. Mortality was more in the patients in this study with undifferentiated acute febrile illness, 43.8% and leptospirosis, 36.4%. Mortality was 48.5% in those who underwent dialysis. But no significant association was identified between requirement of dialysis or diagnosis and mortality. Significant association was identified between patients with breathlessness, basal crepitations, later stage of AKI, inotropic support, ventilator support and mortality with p value <0.05.
 By logistic regression analysis of the factors having association with mortality, requirement of ventilator support and inotropic supports were independent predictors of mortality.
 Conclusion
 The most common etiology was leptospirosis (22%) followed by undifferentiated fever (21%). Mortality was 41% in the patients in the study group. Requirement of ventilator support and inotropic supports were independent predictors of mortality.
Highlights
[1] The tropical zone which is geographically limited by the Tropics of Cancer and Capricorn, is an area with extreme heterogeneity in terms of ethnic composition, as well as the socioeconomic and developmental status
Unlike in the developed nations, were sepsis is a predominant etiologic factor; in high rainfall receiving regions of the tropics - like Kerala, infections like leptospirosis form a major cause of Acute kidney injury (AKI)
Ethical consideration: The above mentioned study was conducted in this institution after obtaining due ethical clearance from the Ethical Committee of Government Medical College, Kottayam
Summary
Acute kidney injury (AKI) complicates 5–7% of acute care hospital admissions and up to 30% of admissions to the intensive care unit. [1] The tropical zone which is geographically limited by the Tropics of Cancer and Capricorn, is an area with extreme heterogeneity in terms of ethnic composition, as well as the socioeconomic and developmental status. Acute kidney injury remains one of the most enigmatic problems in these regions with high incidence rates (25% - 80%) especially in the intensive care units. There are very few studies on the etiologic factors of acute kidney injury in the intensive care units in South India. Management practices and outcome in patients admitted to intensive care units in Kerala has not been studied in depth. The present study was undertaken to identify the etiologic factors and outcome of patients with Acute Kidney Injury admitted in the Medical Intensive Care Unit. Results and Discussion: The most common diagnosis in the patients admitted with AKI in MICU was Leptospirosis (22%) followed by undifferentiated fever (21%) and sepsis seen in 17%. Mortality was more in the patients in this study with undifferentiated acute febrile illness (43.8%) and leptospirosis (36.4%).
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