Abstract
Studies with a comprehensive analysis of the epidemiology of acute kidney injury (AKI) in intensive care units (ICUs) are still limited in developing countries. The aim of this study is to identify the incidence and risk factors of AKI in critically ill patients from a Brazilian ICU. We performed a retrospective analysis of the records of patients admitted to a single-centre adult ICU in Brazil between 1 January 2011 and 31 December 2016. The KDIGO criteria were used to define AKI. Univariate and multivariate data analyses were carried out. We included 1,500 patients. The incidence of AKI was 40.5%, and the AKI dialysis rate was 13%. The predictors of AKI at ICU admission included hypertension [odds ratio (OR) = 1.44, p 0.017], high serum creatinine concentration [OR = 3.54; p < 0.001], low serum albumin concentration [OR = 1.42, p 0.015], high APACHE II score [OR = 2.10; p < 0.001] and high SAPS 3 [OR = 1.75; p < 0.001]. The incidence of AKI was high, and we identified the predictors of AKI among critically ill Brazilian patients. The results of this study may contribute to the implementation of targeted therapies.
Highlights
Studies with a comprehensive analysis of the epidemiology of acute kidney injury (AKI) in intensive care units (ICUs) are still limited in developing countries
The following patients were excluded: those with a medical registry of AKI before ICU admission (ICU-ad); those transferred to the ICU for renal replacement therapy (RRT); those with serum creatinine levels at ICU-ad greater than 4.0 mg/dL; those diagnosed with a chronic kidney disease; those undergoing a kidney transplant; and those with no paper records
To apply the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, we considered the lowest serum creatinine (sCr) at ICU-ad as the baseline value; to identify cases of AKI at ICU-ad, we considered the worst pre-ICU-ad as the baseline creatinine
Summary
Studies with a comprehensive analysis of the epidemiology of acute kidney injury (AKI) in intensive care units (ICUs) are still limited in developing countries. The aim of this study is to identify the incidence and risk factors of AKI in critically ill patients from a Brazilian ICU. In two other large studies, it was found that high serum chloride concentrations[9] and microalbuminuria[10] were well correlated with the development of AKI in nonselected and septic patients, respectively This evidence from large scientific studies grounds the direction of assistance resources, which in developing countries, are very limited and need to be used on a cost-effective basis.
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