Mild to moderate proteinuria is a heralding sign for acute kidney injury and mortality for intensive care unit patients

Hasan H Yeter

doi:10.3906/sag-1802-183

Abstract

Background/aimLack of early predictors of acute kidney injury is currently delaying timely diagnosis.This study was done to evaluate the relationship between mild to moderate proteinuria and incidence of acute kidney injury (AKI) and 28-day mortality in intensive care unit (ICU) patients.Material and methodsThis observational, retrospective study was conducted in the internal medicine ICU. A total of 796 patients were screened and 525 patients were used for this analysis. Proteinuria was measured by urine dipstick test. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.ResultsPatients with dipstick urine protein positivity on admission had higher proportion of AKI and 28-day mortality compared to dipstick urine protein negative group [164 (59.6%) vs. 111 (44.4%) and 101 (36.7%) vs. 54 (21.6%), P = 0.01 and P < 0.01, respectively]. Urine dipstick protein positivity was also a significant predictor of 28-day mortality in patients with GFR > 60 mL/min (hazard ratio: 1.988, 95% confidence interval 1.380–2.862). Conclusion Proteinuria before ICU admission is a risk factor for development of AKI within seven days of ICU stay and also is a risk factor for 28-day mortality, even in patients with GFR > 60 mL/min.

Highlights

Acute kidney injury (AKI) is a frequently seen clinical disorder in intensive care units (ICU)
AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines
Urine protein positive group had more comorbidities including hypertension, diabetes, chronic liver disease, kidney diseases and malignancies according to Charlson comorbidity score compared to dipstick urine protein negative group (P < 0.01)

Summary

Introduction

Acute kidney injury (AKI) is a frequently seen clinical disorder in intensive care units (ICU). Epidemiologic studies have shown that AKI is associated with length of ICU stay, prolonged mechanical ventilation, and mortality [1,2,3]. Patients who survive an episode of AKI are at high risk of progression to chronic kidney disease (CKD) [4]. The incidence in the ICU population is between 20% and 30% depending on the definition used [6]. CKD, septic shock, advanced age, nephrotoxic medications such as vancomycin and colistin, critical illness, circulatory shock, burns, and surgery are well known risk factors for development of AKI in ICU [7]. The incidence of ICU-acquired AKI is higher than

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