POS-044 EPIDEMIOLOGICAL TRENDS IN COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN PAKISTAN: 25 YEARS EXPERIENCE FROM A TERTIARY CARE RENAL UNIT

Abstract

Epidemiological studies of acute kidney injury (AKI) are sparse especially from South Asia. Reported incidences vary with use of different criteria of defining AKI. There is also variation found in different class of income countries, hospital based versus community based AKI. Within hospital based there could be variations in critically ill patients, patients with major surgeries or trauma, association of sepsis and hospital admissions for other reasons. The current study carried out in all adult AKI patients developing community acquired AKI and coming to a tertiary care renal institution in Pakistan from January 1990 to Dec 2014. This is a retrospective data collection from patient’s records and AKI was defined according to KDIGO guidelines. Trends among different groups which are classified in medical, obstetrical and surgical were recorded. The study protocol was in accordance with the Declaration of Helsinki and SIUT’s Institutional Ethical Review Committee has granted permission for collection and presentation of this data. During study period of 25 years; A total of 5,623 patients were diagnosed to have AKI. Patients categorized in Medical, Obstetrical and Surgical causes for AKI. Medical causes contributed 60 %, obstetrical 26% and rest were surgical. Mean age was 35.91± 15.81, 27.83 ±5.66 and 43.24± 16.74 respectively in these groups. In medical AKI there has been found a rise in toxic rhabdomyolysis, vivax malaria and dengue infection during later part of study (table). In obstetrical AKI observed continuous rise in numbers contributing to total AKI during these years. Surgical AKI included obstructed cases during initial ten years and only surgical trauma during later 15 years. The overall requirement for renal replacement therapy was 82 percent, indicating the severity of kidney injury on arrival. Older age on presentation in medical AKI, and thrombocytopenia , deranged coagulation, deranged liver function, hyperkalemia, requirement of mechanical ventilation and multi organ failure in all groups remained predictors of higher mortality. TableMedical AKICAUSESGroup I (1990-1999)Group II (2000 – 2004)Group III (2005 – 2009Group IV (2010 – 2014)Total 25 years (n=3,389)Acute GE302190183178853Malaria21493203251671Rhabdomyolysis673552180334Acute GN/ Vasculitis88323680236Sepsis71312832162Nephrotoxic Drugs74242433155Snake Bite38163031115Poisons138111547Hemolytic Uremic Syndrome18861345Dengue0293243Hepato Renal Syndrome8231427Acute Pancreatitis634619Scorpion Sting1241118Misc. Causes887292105357Unknown Causes42535589239 Open table in a new tab From Pakistan epidemiology for community acquired AKI has never been published on a large scale and this study would remain source of great information in this regard over coming years.