IN-HOSPITAL MORTALITY OF ACUTE KIDNEY INJURY: AN EXPERIENCE FROM SOUTH RAJASTHAN.

Abstract

INTRODUCTION: There are few studies on in-hospital mortality among medical intensive care unit (MICU) patients with acute kidney injury (AKI). We assessed the clinical characteristics of AKI at MICU admission, its impact on mortality during the current hospitalization, and whether the inuence of AKI varied in subgroups of AKI patients. METHODS: We identied all adult aged 12 years and above having medical etiology related community acquired AKI who were admitted to MICU at Pacic Medical College and Hospital, Udaipur, India; from 2015 to 2019. AKI was dened based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria; based on serum creatinine (SCr). Dialysis requiring AKI (D-AKI) was dened as needing acute dialysis at or after MICU admission. Among 2440 MICU patients; 516 patients (21.1%) had AKI. We analyzed in-hospital mortality for subgroups of AKI: stage1, stage2 and stage3: with different etiology, comorbidity levels, acute risk factors, primary hospital diagnosis, and treatment with mechanical ventilation, vasopressors and dialysis. RESULTS: Maximum number of AKI patients (57.8%) were in KDIGO Stage3, while stage1 and stage2 had 17.8% and 24.4% respectively. 51.4% patients were male, median age was 54.81 years and average length of ICU stay was 11.73 days. The most common primary diagnosis and etiology was sepsis (31.4%), the most common acute risk factor was hypovolemia (18.8%), the common chronic comorbidity were diabetes (17.0%) and hypertension (10.0%). The most common presenting symptoms was oliguria (43.8 %), while commonest sign on admission was edema (28.1%). Common indications for dialysis were oliguria (75%), hyperkalemia (38.2%), refractory uid overload (36.2%) and metabolic acidosis (35.2%). Overall common critical care treatment required in AKI patients were acute dialysis (58.9%), vasopressor support (16.5%) and ventilator support (14%). The requirement of dialysis was 0.0%, 4.8% and 100%; among stage1, stage2 and stage3 respectively. The overall AKI mortality was 9.9% (95% condence interval (CI) 7% to 12% ). The associations between AKI and mortality were 10.87% (95% CI 5% to 17%) for the AKI-stage1, 13.49% (95% CI 8% to 19% ) for the AKI-stage2 and 8.05% (95% CI 5% to 11%) for the AKI-stage3. The mortality in D-AKI group was 8.6% (95% CI 5 % to 12 %) compared to the mortality in ND-AKI group 11.8% (95% CI 7 % to 16 %). The association between AKI and in-hospital mortality was evident in all subgroups of AKI; association was more pronounced in stage2 AKI, mostly due to worsening of complications which suggests that KDIGO stage2 AKI is a transition zone among D-AKI and ND-AKI groups. Further, it may be needed to lower the threshold for dialysis criteria in AKI. CONCLUSIONS: Any degree of AKI was associated with increased mortality. Timely and early initiation of dialysis in AKI was an important prognostic factor for the reduction of in-hospital mortality.