Outcomes Of Acute Kidney Injury In Patients Research Articles

Poisoning and Envenomation Induced Acute Kidney Injury: A Hospital-Based Study

Background Most cases of acute kidney injury (AKI) in the Indian subcontinent are community-acquired. Some causes of AKI like poisonings are unique to the local demographics. This study examined the clinical features, spectrum, and outcomes of AKI in patients with poisoning and evaluated the predictors of mortality. Materials and Methods This was a prospective observational study conducted in patients admitted to Jawaharlal Nehru Medical College, Aligarh with an alleged history of poisoning orsnake bite. Relevant history, laboratory tests, mode of treatment, and outcome were recorded for all patients who were followed up after 3 months post discharge. Results During the study period, 394 patients were admitted with a provisional diagnosis of poisoning/snake bite analyzed, of whom 56 (14.2%) developed AKI. Final data analysis was done for 51 patients as 5 patients were lost to follow up. Paraquat poisoning was the most common cause of AKI, seen in 12 patients, followed by methanol in 9 patients. Hemodialysis was required in 29 (56.8%) patients. Complete recovery was seen in 33 (64.7%) patients, and 14 patients (27.5%) died during the acute phase of the illness. Late presentation to the hospital and presence of shock (mean arterial pressure <65 mmHg) on presentation were found to be associated with adverse outcomes (mortality/failure of return of renal function at 3 months). The most common cause of death was septic shock seen in 8 patients. Conclusion This study, which is probably the first from North India, highlights the fact that cases of poisoning/envenomation-related AKI contribute to a sizeable amount of morbidity/mortality.

Incidence and outcome of Acute Kidney Injury in patients admitted in a level III ICU in Nepal: A retrospective, observational study

Background and aims: Acute kidney injury (AKI) is associated with increased mortality, morbidity, and hospital stay. AKI is seen in 20-60% of patients admitted to the intensive care unit (ICU), and mortality is as high as 50% if not managed timely. Burden of AKI is more in developing countries as compared to the developed ones. There is a paucity of published literature regarding incidence and outcome of AKI in critically ill patients from lower-middle income countries like Nepal. This study aimed to determine the incidence and outcome of AKI in patients admitted to a level III ICU in Nepal. Methods: This observational study was conducted in the ICU of Hospital for Advanced Medicine and Surgery (HAMS) Hospital, Kathmandu, Nepal. Data over a period of one year was curated from ICU registry. Eligible patients were screened and the incidence of AKI in ICU admitted patients along with their outcomes (length of ICU stay, need of RRT and ICU mortality) were observed. Results: Among 881 patients admitted to the ICU, 660 patients were enrolled for analysis. Of them, 14.2% of patients developed AKI during ICU stay, out of which 5.3% received RRT and 19.1% died. The median (IQR) length of ICU stay for those who developed AKI was 4 (3-7) days. The 34.0% patients who developed AKI had sepsis. Conclusion: Patients admitted to ICU in this study have high incidence of AKI. In patients who developed AKI, sepsis was the leading cause of ICU admission.

Acute Kidney Injury in Patients with Chronic Liver Disease: A Review

Introduction: Acute kidney injury (AKI) is a frequent complication of chronic liver disease (CLD) contributing to high morbidity and mortality worldwide. While liver transplantation (LT) has shown favorable outcomes, early identification and management of AKI is imperative for survival. This review aims to highlight the epidemiology, pathophysiology, management, and prognosis of AKI in CLD. Methods: An extensive literature search was performed using PubMed, Medline, and Google Scholar to identify literature related to epidemiology, burden, clinical presentations, prognosis, and management of AKI in CLD. Results: The identified studies highlighted a wide range of prevalence of AKI in hospitalized patients with CLD. The etiology and pathophysiology are multifactorial and include prerenal AKI, acute tubular injury, sepsis, gastrointestinal bleeding, bacterial translocation from the gut, and hepatorenal syndrome (HRS). AKI is associated with a higher risk of morbidity and mortality and progression to chronic kidney disease following LT. Management of AKI in CLD varies based on the underlying etiology. While vasoconstrictors like terlipressin have shown great potential in the treatment of HRS-AKI and is widely used in Europe and United States, LT remains the definitive therapy of choice. In most cases, kidney replacement therapy serves as a bridge to liver transplant. Conclusion: AKI is a serious complication of CLD and early identification is essential. Diagnosis and management, particularly HRS is challenging and requires a high index of suspicion. More research is required to identify novel therapies to improve outcomes of AKI in patients with CLD.

Impact of the prognostic nutritional index on renal replacement therapy–free survival and mortality in patients on continuous renal replacement therapy

Background The survival of critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) is highly dependent on their nutritional status. Objectives The prognostic nutritional index (PNI) is an indicator used to assess nutritional status and is calculated as: PNI = (serum albumin in g/dL) × 10 + (total lymphocyte count in/mm3) × 0.005. In this retrospective study, we investigated the correlation between this index and clinical outcomes in critically ill patients with AKI receiving CRRT. Methods We analyzed data from 2076 critically ill patients admitted to the intensive care unit at Changhua Christian Hospital, a tertiary hospital in central Taiwan, between January 1, 2010, and April 30, 2021. All these patients met the inclusion criteria of the study. The relationship between PNI and renal replacement therapy-free survival (RRTFS) and mortality was examined using logistic regression models, Cox proportional hazard models, and propensity score matching. High utilization rate of parenteral nutrition (PN) was observed in our study. Subgroup analysis was performed to explore the interaction effect between PNI and PN on mortality. Results Patients with higher PNI levels exhibited a greater likelihood of achieving RRTFS, with an adjusted odds ratio of 2.43 (95% confidence interval [CI]: 1.98-2.97, p-value < 0.001). Additionally, these patients demonstrated higher survival rates, with an adjusted hazard ratio of 0.84 (95% CI: 0.72-0.98) for 28-day mortality and 0.80 (95% CI: 0.69-0.92) for 90-day mortality (all p-values < 0.05), compared to those in the low PNI group. While a high utilization rate of parenteral nutrition (PN) was observed, with 78.86% of CRRT patients receiving PN, subgroup analysis showed that high PNI had an independent protective effect on mortality outcomes in AKI patients receiving CRRT, regardless of their PN status. Conclusions PNI can serve as an easy, simple, and efficient measure of lymphocytes and albumin levels to predict RRTFS and mortality in AKI patients with require CRRT.

Clinical and Biochemical Characteristics of COVID-19-Associated Acute Kidney Injury (COVAKI): A Proof-of-Concept Case-Control Study.

Introduction Acute kidney injury (AKI) develops in 20-70% of patients with COVID-19. AKI is a syndromic diagnosis with multiple causes and outcomes. This cross-sectional study explored different outcomes of AKI in patients admitted with COVID-19. Material and methods It was a cross-sectional and descriptive study carried out in a tertiary care teaching hospital in Western Maharashtra for two months (May to June 2020). We collected clinical and laboratory data of 456 inpatients admitted with COVID-19 over two consecutive months. We excluded patients already on dialysis upon arrival at the hospital. It predominantly consists of patients who developed AKI during their stay in the hospital. Result C-reactive protein (CRP) was elevated in patients with COVID-19 associated with AKI (COVAKI) (78.87) but was statistically significant (p<0.003). Ferritin was elevated significantly (1619.19) in patients with AKI (p<0.0001). Similarly, higher levels of D-dimer (426.35) and lower serum albumin (1.86) were associated with COVAKI (p<0.0001). The average ICU stay was six days for patients with AKI and 0.37 days for patients without AKI. Days on the ventilator were 3.3 days for patients with AKI and 0.11 days for non-AKI patients. Out of a total 12 deaths of COVID-19 patients over these two months, nine had AKI. This made the association statistically significant (p<0.0001). Conclusion The phenotype COVAKI was associated with higher inflammatory markers, prolonged hospital stay, days spent on a ventilator, and higher oxygen requirement translating into higher mortality compared to those without COVAKI. We found low serum albumin without a corresponding proteinuria or liver dysfunction. The development of COVAKI during the hospital stay was associated with the use of glucocorticoids, hydroxychloroquines (HCQs), and heparin.

Risk and Time-to-Onset of Acute Kidney Injury With Vancomycin Plus Piperacillin-tazobactam Combination: Analysis Using JADER.

Pharmacovigilance data and clinical studies have indicated a risk of acute kidney injury (AKI) associated with concomitant administration of vancomycin and piperacillin-tazobactam. However, no pharmacovigilance studies have evaluated time-to-onset and outcomes of AKI related to this combination. Therefore, this study used a pharmacovigilance database to investigate the incidence, time-to-onset, and outcomes of AKI in patients treated with intravenous vancomycin plus piperacillin-tazobactam or other antipseudomonal antibiotics. From data in the Japanese Adverse Drug Event Report (JADER) database, we calculated the reporting odds ratios (RORs) and 95% confidence intervals (CIs), time-to-onset, and outcomes of AKI following intravenous administration of vancomycin plus piperacillin-tazobactam or other antipseudomonal antibiotics and with other vancomycin regimens, including monotherapy. The JADER database contained 4,471 reports of intravenous vancomycin treatment, including 517 reports of AKI. The adjusted RORs (95%CIs) of AKI in cases with co-administration of intravenous vancomycin and piperacillin-tazobactam was 2.58 (2.06-3.24). The median time-to-onset for AKI in vancomycin plus piperacillin-tazobactam was 6.0 (interquartile range=3.0-10.3). Weibull shape parameter analysis showed that the pattern of onset of AKI in vancomycin plus piperacillin-tazobactam represented a wear out failure, predicting an increasing hazard with time. For the outcome of AKI, there was no significant difference between all vancomycin regimen and the piperacillin-tazobactam combination groups. Concomitant use of intravenous vancomycin and piperacillin-tazobactam may increase the incidence of AKI but may not affect the outcome. This combination does not necessarily have to be avoided, but long-term use is not advisable.

Acute Kidney Injury in Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study.

Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal therapy to support oxygenation of patients with severe cardiac or respiratory failure. Studies have shown that acute kidney injury (AKI) can worsen the outcome in these patients. This study aims to assess the incidence and outcome of AKI in patients on ECMO support. This retrospective study included 64 patients who underwent ECMO for more than 24 hours. Patients who died within 48 hours of initiation of ECMO and patients with end-stage renal disease (ESRD) on maintenance hemodialysis were excluded. Acute kidney injury was diagnosed and categorized according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of the 64 patients studied, 38 patients (59.38%) developed AKI and 17 patients (44.73%) among them developed AKI within 24 hours of initiation of ECMO. Age, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, hypertension, use of nephrotoxic agents, inotropic support, and poor cardiac function were the risk factors associated with the development of AKI. Diabetes mellitus, type of ECMO used, and duration of ECMO were not found to be risk factors for AKI. Renal replacement therapy was initiated in 31 patients (81.58%). The overall mortality in the whole group was 67.19%, while it was 81.58% among the patients with AKI. Acute kidney injury was found to be an independent risk factor for mortality in patients on ECMO. Early identification of the risk factors for AKI and management may help to improve the survival rate. The occurrence of AKI among patients on ECMO support increases the risk of mortality significantly. Hence, measures to prevent AKI, as well as early detection and appropriate management of AKI, would improve patient outcomes. Surjit A, Prasannan B, Abraham J, Balagopal A, Unni VA. Acute Kidney Injury in Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study. Indian J Crit Care Med 2024;28(1):26-29.

Clinical characteristics and outcomes of acute kidney injury in patients with severe fever with thrombocytopenia syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis caused by a novel bunyavirus. Until recently, the SFTS related acute kidney injury (AKI) was largely unexplored. This study aimed to investigate the clinical characteristics and outcomes of AKI in patients with SFTS. The non-AKI and AKI groups were compared in terms of general characteristics, clinical features, laboratory parameters and cumulative survival rate. The independent risk factors for in-hospital mortality in patients with SFTS were analyzed by multivariate logistic regression to identify the population with poor prognosis. A total of 208 consecutive patients diagnosed with SFTS were enrolled, including 153 (73.6%) patients in the non-AKI group and 55 (26.4%) patients in the AKI group. Compared with patients without AKI, patients with AKI were older and had a higher frequency of diabetes. Among these laboratory parameters, platelet count, albumin and fibrinogen levels of patients with AKI were identified to be significantly lower than those of patients without AKI, while ALT, AST, ALP, triglyceride, LDH, BUN, uric acid, creatine, Cys-C, β2-MG, potassium, AMY, lipase, CK-MB, TnI, BNP, APTT, thrombin time, D-dimer, CRP, IL-6, PCT and ESR levels were significantly higher in patients with AKI. A higher SFTS viral load was also detected in the AKI patients than in the non-AKI patients. The cumulative survival rates of patients at AKI stage 2 or 3 were significantly lower than those of patients without AKI or at AKI stage 1. However, there was no significant difference in the cumulative survival rates between patients without AKI and those with stage 1 AKI. Univariate and multivariate binary logistic regression analyses demonstrated that stage 2 or 3 AKI was an independent risk factor for in-hospital mortality in patients with SFTS. AKI is associated with poor outcomes in patients with SFTS, especially patients at AKI stage 2 or 3, who generally have high mortality. Our findings support the importance of early identification and timely treatment of AKI in patients with SFTS.

#4314 IMPACT OF ACUTE KIDNEY INJURY ON OUTCOME OF SEVERE FEVER WITH THROMBOCYTOPENIA SYNDROME

Abstract Background and Aims Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with a high case-fatality rate in East Asia. In addition, acute kidney injury (AKI) has been reported in 14∼36% of the SFTS virus-infected patients. However, the risk factor for AKI and the clinical outcome of AKI in patients with SFTS has not been well understood. Method Patients who confirmed SFTS virus infection during five years from 2016 to 2020 in Kangwon national university hospital were retrospectively reviewed. Their laboratory data and medical records, such as comorbidity, complications, and mortality, were obtained from the electronic medical record. AKI was defined according to KDIGO criteria. The risk factors for death were assessed by Cox proportional hazards regression analysis. Results Of the 53 patients, 29 (54.7%) were male, and the mean age was 66.5 years. Twenty-seven (50.9%) patients were defined as AKI; 17 patients were AKI stage 1, 5 patients were AKI stage 2, and 5 patients were AKI stage 3. Of these, 5 patients underwent dialysis and all of them needed continuous renal replacement therapy. Patients with AKI were significantly older and had a higher proportion of diabetes (p = 0.041 and p = 0.019, respectively). In baseline laboratory tests, levels of aspartate aminotransferase, alanine aminotransferase and c-reactive protein were higher in AKI group (p = 0.011, p = 0.019, and p = 0.012, respectively). Among 53 patients, nine died due to SFTS, and the fatality rate was 15.1%. The AKI group (29.6%) had a higher mortality rate than the no AKI group (3.8%). In univariate analysis, higher levels of white blood cells, blood urea nitrogen, creatinine, and alkaline phosphatase were risk factors for death. In multivariate analysis, leukocytosis and AKI stage 3 were independent risk factors for death. Conclusion AKI frequently occurs among patients with SFTS. In patients with AKI stage 3, the mortality rate is significantly higher than no or mild AKI, so special attention should be paid when it occurs.

Clinical Considerations for Patients Experiencing Acute Kidney Injury Following Percutaneous Nephrolithotomy.

Acute kidney injury (AKI) is a common postoperative outcome in urology patients undergoing surgery for nephrolithiasis. The objective of this study was to determine the prevalence of postoperative AKI and its degrees of severity, identify risk factors, and understand the resultant outcomes of AKI in patients with nephrolithiasis undergoing percutaneous nephrolithotomy (PCNL). A cohort of patients admitted between 2012 and 2019 to a single tertiary-care institution who had undergone PCNL was retrospectively analyzed. Among 417 (n = 326 patients) encounters, 24.9% (n = 104) had AKI. Approximately one-quarter of AKI patients (n = 18) progressed to Stage 2 or higher AKI. Hypertension, peripheral vascular disease, chronic kidney disease, and chronic anemia were significant risk factors of post-PCNL AKI. Corticosteroids and antifungals were associated with increased odds of AKI. Cardiovascular, neurologic complications, sepsis, and prolonged intensive care unit (ICU) stay percentages were higher in AKI patients. Hospital and ICU length of stay was greater in the AKI group. Provided the limited literature regarding postoperative AKI following PCNL, and the detriment that AKI can have on clinical outcomes, it is important to continue studying this topic to better understand how to optimize patient care to address patient- and procedure-specific risk factors.

Clinical Outcomes for Acute Kidney Injury in Acute Myocardial Infarction Patients after Intra-Aortic Balloon Pump Implantation: A Single-Center Observational Study.

Acute kidney injury (AKI) is common after cardiac interventional procedures. The prevalence and clinical outcome of AKI in patients with acute myocardial infarction (AMI) after undergoing intra-aortic balloon pump (IABP) implantation remains unknown. The aim of this study was to investigate the incidence, risk factors, and prognosis of AKI in specific patient populations. We retrospectively reviewed 319 patients with AMI between January 2017 and December 2021 and who had successfully received IABP implantation. The diagnostic and staging criteria used for AKI were based on guidelines from "Kidney Disease Improving Global Outcomes". The composite endpoint included all-cause mortality, recurrent myocardial infarction, rehospitalization for heart failure, and target vessel revascularization. A total of 139 patients (43.6%) developed AKI after receiving IABP implantation. These patients showed a higher incidence of major adverse cardiovascular events (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.06-2.26, p = 0.022) and an increased risk of all-cause mortality (HR: 1.62, 95% CI: 1.07-2.44, p = 0.019). Multivariable regression models found that antibiotic use (odds ratio [OR]: 2.07, 95% CI: 1.14-3.74, p = 0.016), duration of IABP use (OR: 1.24, 95% CI: 1.11-1.39, p 0.001) and initial serum creatinine (SCr) (OR: 1.01, 95% CI: 1.0-1.01, p = 0.01) were independent risk factors for AKI, whereas emergency percutaneous coronary intervention was a protective factor (OR: 0.35, 95% CI: 0.18-0.69, p = 0.003). AMI patients who received IABP implantation are at high risk of AKI. Close monitoring of these patients is critical, including the assessment of renal function before and after IABP implantation. Additional preventive measures are needed to reduce the risk of AKI in these patients.

Acute kidney injury in Coronavirus disease-19 related pneumonia in the intensive care unit: a retrospective multicenter study, Saudi Arabia.

Acute kidney injury (AKI) poses a significant morbidity and mortality risk to critically ill COVID-19 patients. The aim of this study was to investigate the incidence, predictors, and outcomes of AKI in patients admitted to the intensive care unit (ICU) with critically ill COVID-19 pneumonia. A multicenter retrospective study in Saudi Arabia of adult patients aged at least 18 years diagnosed with COVID-19 pneumonia and admitted to the intensive care unit between May 2020 and May 2021 was conducted. The occurrence of AKI and associated risk factors, the need for continous renal replacement therapy (CRRT), and the outcome were reported. The study included 340 patients admitted to the ICU with COVID-19. Their mean age was 66.7±13.4 years, ranging from 49 to 84 years, and most of them were men (63.8%). The most common concomitant diseases were hypertension (71.5%), diabetes (62.4%), IHD (37.6%), CKD (20%), heart failure (19.4%), and 81.2% suffered from ARDS. AKI occurred in 60.3% of patients, 38% were stage 1, 16.6% were stage 2, and 45.4% were stage 3. Approximately, 39% of patients required CRRT, out of which 76.2% were stage 3, which was significantly higher than the other stages (p<0.001). AKI patients suffered significantly from asthma and had lower levels of C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and blood urea nitrogen (BUN) and higher creatinine levels than patients without AKI (p<0.05 all). The overall mortality rate was 39.4%, and the mortality rate was significantly higher in patients with AKI than in patients without AKI (48.3% versus 25.9%; p<0.001). AKI is common in adults admitted to the ICU with COVID-19 and is associated with an increased risk of death. Early detection of AKI and appropriate treatment can positively impact COVID-19 outcome. CRRT is the preferred dialysis method in critically ill ICU patients with AKI.

High incidence of acute kidney injury among patients with major trauma at Mulago National Referral Hospital, Uganda: risk factors and overall survival.

Acute kidney injury (AKI) is a common and life-threatening complication of major trauma. Recognition is often delayed and management is frequently sub-optimal. We determined the incidence, risk factors and immediate outcomes of AKI in patients with major trauma at Mulago National Referral Hospital. This was a prospective study. We recruited adult patients with ISS of > 16. The KDIGO criteria was used to stage AKI. Serum creatinine was measured at baseline, 24, 48, 72 hours and on discharge from the study. Participants were followed up for seven days if not yet discharged. Bivariate and multivariate analysis was done using modified Poisson regression with robust standard errors. 224 patients were recruited. The incidence was 67/1000 persons per day. The risk factors were male sex, delayed presentation, hypoglycemia at admission, RR=1.62 (95%CI 1.24-2.12) and non-operative management RR=1.39 (95%CI 1.02-1.89). Out of the 62 patients that died, 34 (54.8%) had AKI. The overall mortality rate was 39.5 patients per thousand per day. There was a high incidence of AKI among patients with major trauma. Efforts to reduce morbidity and mortality should be prioritized.

Aetiological factors, outcomes and mortality risk of acute kidney injury in hospitalized patients in a tertiary health centre in Nigeria: An eleven year review

Acute kidney injury is a major public health issue in Nigeria, and it is associated with an increase in mortality. The study’s goal was to look at the most common precipitating factors, outcomes, and risk factors associated with mortality in our patients. This study examined the medical records of 11 years, of of hospitalized adult patients with confirmed Acute Kidney Injury (AKI). The patient record was searched for relevant information. The Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria were used to define AKI. The logistic regression analysis was used to determine the risk factors associated with mortality. A total of 399 patients were analysed. The overall mean age was 45.0 ± 17.3. The older age group (≥ 60years) compared to the younger group (&lt;60 years) developed hospital acquired AKI (10% vs 5%). Pre-existing diseases like, hypertension (p&lt;0.001), diabetes mellitus (p&lt;0.001), anemia (p&lt;0.001), stroke (p&lt;0.001) and malignancy (p&lt;0.001) were significantly higher in the older group. More of the older age group had more than 1 comorbidity (66 vs. 48%), were on diuretic and ACEI. The commonest causes/precipitants of AKI were septicaemia and other infections (62%) and hypovolaemia/hypoperfusion (45%). Overall mortality was 34%. The median length of stay was 11 (7.20) days, 25% had hemodialysis and 16% were admitted in the ICU. The risk factors for mortality identified were, hospital acquired AKI (OR: 6.59, 95% CI: 1.320-32.889, p=0.021), ICU admission (OR: 5.66, 95% CI: 2.061–15.512, p=0.001) and HIV infection (OR: 2.61, 95% CI: 1.063-6.424, p=0.036). The Commonest causes of AKI still remain infections and hypovolaemia and mortality from it was high in our patient population. Early identification of AKI and those at high risk of mortality and provision of adequate treatment are critical to improving outcomes in AKI patients.

POS-011 CORRELATION OF CLINICAL AND BIOCHEMICAL CHARACTERISTICS OF ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19: A SINGLE CENTER EXPERIENCE

Acute kidney injury (AKI) develops in 20 to 70 % of patients with COVID-19 and is associated with high mortality. The exact mechanism of COVID-19 associated kidney injury is unclear. This retrospective study was aimed at exploring incidence, severity and outcome of AKI in patients admitted with COVID-19. Our study was retrospective observational study so it has its own limitations. Hospitalization criteria were different at that time. Still, we noticed that a significant proportion of patients developed AKI during the course of their disease.

The incidence and outcome of AKI in patients with sepsis in the emergency department applying different definitions of AKI and sepsis

BackgroundSepsis is often accompanied with acute kidney injury (AKI). The incidence of AKI in patients visiting the emergency department (ED) with sepsis according to the new SOFA criteria is not exactly known, because the definition of sepsis has changed and many definitions of AKI exist. Given the important consequences of early recognition of AKI in sepsis, our aim was to assess the epidemiology of sepsis-associated AKI using different AKI definitions (RIFLE, AKIN, AKIB, delta check, and KDIGO) for the different sepsis classifications (SIRS, qSOFA, and SOFA).MethodsWe retrospectively enrolled patients with sepsis in the ED in three hospitals and applied different AKI definitions to determine the incidence of sepsis-associated AKI. In addition, the association between the different AKI definitions and persistent kidney injury, hospital length of stay, and 30-day mortality were evaluated.ResultsIn total, 2065 patients were included. The incidence of AKI was 17.7–51.1%, depending on sepsis and AKI definition. The highest incidence of AKI was found in qSOFA patients when the AKIN and KDIGO definitions were applied (51.1%). Applying the AKIN and KDIGO definitions in patients with sepsis according to the SOFA criteria, AKI was present in 37.3% of patients, and using the SIRS criteria, AKI was present in 25.4% of patients. Crude 30-day mortality, prolonged length of stay, and persistent kidney injury were comparable for patients diagnosed with AKI, regardless of the definition used.ConclusionThe incidence of AKI in patients with sepsis is highly dependent on how patients with sepsis are categorised and how AKI is defined. When AKI (any definition) was already present at the ED, 30-day mortality was high (22.2%). The diagnosis of AKI in sepsis can be considered as a sign of severe disease and helps to identify patients at high risk of adverse outcome at an early stage.

Clinical profile of patients with acute kidney injury admitted in intensive care unit

Background: Acute kidney injury (AKI) is a frequent complication in critically sick patients admitted to the intensive care unit (ICU). The objective of this study was to assess the risk factors and clinical outcomes of AKI in patients admitted to a teaching hospital's intensive care unit.Methods: This prospective observational study was conducted in the department of internal medicine, Janaki Medical College, Janakpur, Nepal from June 2018 till May 2019. Adults (aged 18 years or more) diagnosed with AKI using RIFLE criteria and were either admitted in ICU with diagnosis of AKI or developed AKI after admission to ICU. AKI patients were classified as those who satisfied any of the RIFLE categorization criteria.Results: The most common presenting complaint was fever (77%). The most common etiology of AKI was sepsis (71%). Other causes of AKI were post-operative cases (16%) and alcoholic liver disease (13%). When classified as per RIFLE criteria, we classified 38 cases (31.9%) as ‘risk’, 53 (44.54%) as ‘injury’ and 28 (23.53%) as ‘failure’. The etiological classification of our patients to be significantly associated with RIFLE classification (p&lt;0.01). However, we found the mortality not to be significantly associated with RIFLE classification (p=0.74). Conclusions: AKI classification should be used as a risk assessment tool towards the AKI's influence on the prognosis of ICU patients. Further study should investigate determining the death rate according to the RIFLE criteria in this region of Nepal.

Study of Acute Kidney Injury in Patients Hospitalized with COVID-19: A Single Center Study in Bangladesh

Introduction: The incidence of acute kidney injury (AKI) associated with hospitalized corona virus disease -19(Covid- 19) patients and associated outcomes are not well determined. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. Material &amp; Methods: In this cross sectional study, we reviewed the health records for all conveniently selected patients hospitalized with Covid-19 irrespective of co morbidity from 1st May to 31st July, 2020, at combined military hospital Dhaka, Bangladesh. Patients younger than 18 years, end stage kidney disease or with a kidney transplant recipient were excluded from the study. AKI was deûned according to kidney disease improving global outcome (KDIGO) criteria. Results: A total of 470 Covid-19 patients were recruited in this current study, out of them 67.02% were male and 32.98% of were female; with male to female ratio was 2:1. The mean age of the study population was 54.71(±14.31) years. AKI developed among 106 (22.55%) patients of whom 50 patients had CKD. The peak stages of AKI were stage 3 in 58(12.34%), followed by stage 1 in 37(7.87%), and stage 2 in 11(2.34%) patients. Renal replacement therapy was required (RRT) for 37(7.87%) patients. Risk factors included older age, hypertension, diabetes mellitus, cardiovascular disease, and chronic kidney disease and those who presented with prolong fever and breathlessness.AKI was commonly seen in patients with severe disease. Considerable number of patient had proteinuria 222(47.23%) and haematuria in 63 (13.40%) and were significantly associated with AKI. Elevated level of ferritin, D-dimer and procalcitonin were observed among 249(52.98%), 179(38.08%) and 138(35, 88%) patients respectively which were substantially correlated with AKI. COVID-19 patients complicated to acute kidney injury were strongly associated with higher mortality19 of 23 (82.60%). Conclusion: Renal involvement in COVID-19 (Corona virus-nephropathy) has a complex etiology. It is closely associated with severity of disease and indicating poor prognosis. Further study will be needed for better understanding the causes of AKI and patient outcomes. J Bangladesh Coll Phys Surg 2022; 40: 79-86

POS-857 RISK FACTORS AND SHORT-TERM OUTCOMES OF ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS WITH COVID-19: A DOUBLE CENTER RETROSPECTIVE STUDY

Acute kidney injury (AKI) in COVID-19 is considered both a marker of disease severity and a negative prognostic factor for survival. Reported data on AKI in COVID-19 patients in the Philippines is very limited. This study aimed to determine the incidence, risk factors and short-term outcomes of AKI in patients hospitalized with COVID-19 in a tertiary hospital in Cebu. This retrospective, double-center, observational cohort study was done in two separate private tertiary hospitals under the same institution in Cebu. A total of 535 patients were included in this study and all data were gathered through chart review. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Binary logistic regression analyses were performed to determine the risk factors and the association between the stages of AKI and in-hospital mortality. A p-value < 0.05 (two-tailed) was considered statistically significant. Among 535 patients included in this study, AKI developed in 150 (28%). Median age was 65 years and 60.67% were males. Hypertension (74%), diabetes mellitus (50%), and chronic kidney disease (19.33%) were the most common co-morbid conditions and were frequently observed in stage 3 AKI. The peak stages of AKI were stage 1 in 32%, stage 2 in 18.67% and stage 3 in 49.3%. Of these, 35.3% required renal replacement therapy (RRT). The risk factors identified included age, hypertension, CKD, proteinuria, hematuria, pyuria, procalcitonin, mechanical ventilator use, vasopressor use, ICU admission, and illness severity. AKI was observed in greater frequency among patients with respiratory failure, with 67.9% of patients on mechanical ventilation developing AKI compared to only 15% in non-ventilated patients. Among 53 patients who required RRT, 46 (86.79%) were intubated. The median time of intubation to AKI diagnosis was 24 hours. Furthermore, 63% of patients with AKI had major adverse kidney events with in-hospital mortality accounting for 56.6%. The odds of mortality increased by 1.4 times for every increase in AKI stage. Additionally, a total of 113 patients died and of these, 85 (75.2%) had AKI. Acute kidney injury occurred in more than one-fourth of hospitalized patients with COVID-19. Its development occurs in temporal association with respiratory failure and the time of intubation. The rate of in-hospital mortality was significantly higher among patients with AKI. Furthermore, there is a stepwise increase in the mortality rate for every increase in the severity of AKI.

Incidence and Outcome of Acute Kidney Injury in Patients Hospitalized With Coronavirus Disease-19 at a Tertiary Care Medical Center in Saudi Arabia.

IntroductionThe systemic acute respiratory syndrome coronavirus (SARS-CoV-2) has been associated with acute kidney injury (AKI). We retrospectively studied the incidence and outcome of AKI in patients hospitalized with COVID-19 at King Abdulaziz Medical City (KAMC) Riyadh, Kingdom of Saudi Arabia.MethodsA retrospective cohort study was conducted after ethical approval from the institutional review board of King Abdullah International Medical Research Center (KAIMRC). Subjects were identified by Data Management Office of KAIMRC. The data were extracted from electronic medical records using a customized data collection sheet.The study included all adult patients (>18 years) who tested positive for COVID-19 by polymerase chain reaction and were admitted at KAMC from March 2020 until the end of September 2020. Patients with a history of end-stage kidney diseases and patients where adequate data were not available to establish diagnosis of AKI were excluded.Patient demographics, comorbid conditions, medications, use of mechanical ventilation, and 30-day mortality were recorded.ResultsDuring the study period (01 March 2020 to 30 September 2020) 1293 patients were hospitalized at KAMC with the diagnosis of COVID-19. After excluding the patients who met the exclusion criteria, data were collected for 1025 patients [male 582 (56.8%); female 443 (43.2%)]. On univariate analysis, increasing age, male gender, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, and vasopressors, presence of chronic kidney disease, coronary artery disease, chronic obstructive pulmonary disease, dyslipidemia, diabetes mellitus, heart failure, and hypertension, kidney transplant status, and mechanical ventilation were associated with development of AKI.On multivariate logistic regression analysis, independent predictors of AKI were restricted to increasing age, presence of chronic kidney disease, hypertension, kidney transplant status, use of vasopressors, and mechanical ventilation.For patients who developed AKI, 30-day mortality was 40.7% compared to 3.7% for those who did not develop AKI (p<0.001).ConclusionFor hospitalized patients with COVID-19, we observed an incidence of AKI of 36%. Increasing age, presence of chronic kidney disease and hypertension, kidney transplant status, use of vasopressors, and mechanical ventilation were independently associated with development of AKI. Presence of AKI was associated with higher 30-day mortality (40.7% vs 3.7%).