Epidemiology and Outcomes from AKI Dr SEOW YEING YEE Acute kidney injury (AKI) portends serious clinical consequences and heightened resource utilization. Reported incidence of AKI in other parts of the world range from 14.7% to 32.5%. However incidence and outcome of AKI in Malaysia are not well documented. This study evaluated the incidence, associated risk factors, outcome, nephrology consultation and requirement for renal replacement therapy (RRT) in patients with AKI in Hospital Kuala Lumpur (HKL). A prospective, observational study was conducted on patients admitted in March 2017 aged ≥18 years old. All serum creatinine were evaluated and analyzed. Patients were included in the study if they fulfill the AKI criteria of Kidney Disease Initiative in Global Outcome. Patients with kidney transplant or stable chronic kidney disease were excluded. 431 of 7727 patients were included while 100 records were unavailable and 8 patients were still in ward, giving an AKI incidence of 7%. Two thirds (65.2%) were male and 61% were Malay. Mean age was 55.7 ± 17. Average length of hospital stay was 10.8 ± 8.1 days. Two-thirds (66.6%) were medical patients while one-third was surgical patients. ICU admission comprised 17.2% of the AKI incidents while the remaining were in the wards. 52.4% had hypertension while 45% were diabetics. Poor survival was associated with chronic liver disease. Commonest aetiologies for AKI were infection (55.5%) and pre renal/ischaemic causes (42.7%). 18.8% of patients with AKI were referred for nephrology consult whilst 11.3% were undiagnosed. Only 34 (7.9%) patients required renal replacement therapy (RRT) for average duration of 6 days. Most (82%) patients recovered full or partial renal function but 2.6% had worse kidney function or became dialysis dependent at discharge. Inpatient mortality was 15% but was higher in ICU patients compared to ward patients, with odds ratio (OR) 6.3. If they received RRT, the mortality rate was 56% (OR 9.7) This was the first study reporting AKI incidence in HKL but there were many limitations, including unavailable patient records, short period of study and using solely serum creatinine to define AKI. AKI in critically ill patients have significantly higher mortality, especially if they required RRT in hospital.Table 1Died (n= 64)Survive (n= 362)p valueAge54.0 ± 16.056.1 ± 17.20.27Length of stay11.7 ± 9.110.7 ± 7.90.54Gender0.46 Male45236 Female20130Ethnicity0.11 Orang Asli01 Malay35228 Chinese1550 Indian971 Foreigner616Discipline0.94 Medical43244 Surgical22122Comorbidities Diabetes mellitus281660.734 Hypertension301960.271 Ischaemic heart disease12690.941 Chronic kidney disease8540.605 Cancer2330.106 Liver disease780.001 Lung disease8400.745 Stroke3220.657 HIV060.299Aetiology Infection441950.031 Ischaemic/Pre-renal311530.376 Malignancy5230.671 Obstruction1230.124 Intrarenal0110.157Location<0.001OR 6.3 Intensive care unit3044 Ward35322Nephrology Consult<0.001OR 3.8 Yes2655 No39311RRT<0.001OR 9.7 Yes1915 No46351HIV: human immunodeficiency virusRRT: renal replacement therapyOR: odds ratio Open table in a new tab