SUN-168 OUTCOMES OF ACUTE KIDNEY INJURY FOLLOWING HEMOTOXIC SNAKE ENVENOMATION

Abstract

Snake envenomation is a common cause of acute kidney injury in the tropics. There is only limited data on predictors of mortality and long-term outcomes of snake bite related AKI. The current study aims to identify the predictors of mortality in patients with snake bite AKI. The study also aims to assess the long-term outcomes (GFR <60 ml, urine albumin excretion > 30, presence of hypertension/prehypertension) in patients who recover from snake bite AKI. All adult patients admitted with features of systemic haem toxicity and AKI from January 2016 to June 2017, were recruited for the study . AKI was defined according to KDIGO criteria . Patients with history history of CKD were excluded . Demographic, clinical and laboratory details were collected during hospital admission. A first follow up visit was scheduled 2 weeks after discharge from the hospital. All patients were called for the final follow up visit in June 2018. Among a total number of 420 patients with hemotoxic snake bites , 214 (50.9 %) had features of systemic hemotoxicity . 184 patients (43.8 %) satisfied the KDIGO criteria for AKI( stage 1= 14 (07.6 %),stage 2- 35(19%),stage 3- 115(62.5%). KDIGO urine output as well as creatinine criteria was met in 106 (57.6%) patients . 45(24.5%) patients met only the creatinine criteria and 33 (17.9%) met only urine output criteria. The comorbidities present in the population were systemic hypertension (n=7) and diabetes mellitus (n=2). The mortality rate for patients with hemotoxic envenomation was 21.1% (n = 46 /214). The mortality was considerably higher in patients with stage 3 AKI ( RR- 5.05 ; 95% CI 1.28 -19.85) as well as those who met both urine output and creatinine criteria (RR- 3 .02; 95% CI 2.01-4.53). On cox regression analysis, the independent predictors of mortality were presence of capillary leak syndrome (RR- 2.02; 95% CI 1.05-3.88), mechanical ventilation (RR- 5.59; 95% CI 2.90 -10.81) and hypotension (RR- 2.48; 95% CI h1.31-4.72). Among the survivors (n=140), at the time of discharge, 44 patients (31.4%) had a complete recovery of kidney function . At 2 weeks post discharge, 23 patients had e GFR values < 60 ml/1.73 m 2 (32.3%). Long term follows up data was available for 53 patients. The median follows up duration was 20 months (IQR 6-24.5). The mean eGFR at the end of follow up was 85.62 ml /1.73 m2 (95% CI 79.1,92.2). A total of 12/53(22.6%) patients developed adverse renal outcomes at the end of follow up . Among these . 08 patients (15%) patients developed CKD, 3 patients developed prehypertension and one patient had new onset hypertension. Kidney biopsy was done in three patients, chronic thrombotic microangiopathy was documented in 2 patients and one patient showed persistent acute tubular necrosis Higher stages of AKI,mechanical ventilation,hypotension and capillary leak were associated with a higher risk of mortality in snake bite related AKI. One fifth of patients who sustain AKI following snake envenomation develop adverse renal outcomes on follow up.