A SINGLE-CENTER STUDY EVALUATING THE PREVALENCE, RISK FACTORS, AND CONSEQUENCES OF ACUTE KIDNEY INJURY IN THE INTENSIVE CARE UNIT

Authors

  • R PERVAIZ Department of Internal and Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan.
  • MA QAYYUM Department of Nephrology, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
  • SA KHALID Department of Nephrology, Rashid Latif Khan University, Lahore, Pakistan
  • T HAFEEZ Department of Nephrology, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
  • MU MUNAWAR Department of Internal and Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan.
  • HMH ARIF Department of Internal and Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan.
  • H KANDEEL Department of Critical Care Medicine, Hatta Hospital, Dubai Health, UAE.
  • WG ELMASRY Medical Intensive Care Unit, Rashid Hospital, Dubai Health, Dubai, UAE.
  • S RAZA Department of Internal and Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan.

DOI:

https://doi.org/10.54112/pjicm.v4i01.22

Keywords:

Acute Kidney Injury, Critical Illness, Intensive Care Units, Mortality, Risk Factors

Abstract

Background: Acute kidney injury (AKI) is a significant complication in critically ill patients in intensive care units (ICUs), impacting morbidity, mortality, and overall patient outcomes. Objectives: To assess the frequency, risk factors, and implications of AKI among individuals admitted to the medical ICU at Bahria International Hospital between 2021 and 2022. Study Design: This study utilized a retrospective design. Setting: The study was conducted at Bahria International Hospital's medical ICU. Duration of Study: Data were collected between September 2022 and September 2023. Material and Methods: AKI frequency and risk factors were assessed using the Acute Kidney Injury Network (AKIN) criteria for staging. Risk factors such as age, hypertension, ACEI/ARB usage, and severity of underlying illnesses (measured by APACHE II scores) were analyzed. Multivariate analysis was performed to identify independent predictors of AKI occurrence. Results: The study found that 32.7% of ICU patients experienced AKI, primarily categorized as stage 1 AKI (60.12%). Advanced age, hypertension, ACEI/ARB usage, and higher APACHE II scores were significant risk factors for AKI development. Multivariate analysis identified age (HR 1.3, 95% CI 1.2-1.5, P = 0.01) and APACHE II score (HR 1.6, 95% CI 1.3-1.8, P = 0.02) as independent predictors of AKI occurrence. Conclusion: The incidence of AKI among ICU patients is substantial and associated with increased mortality and morbidity. Early identification and management of modifiable risk factors are crucial for mitigating AKI-related complications and improving patient outcomes. Proactive measures in critical care settings are necessary to reduce AKI burden and enhance patient care.

References

Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. Journal of the American Society of Nephrology. 2005;16(11):3365-70.

Priyamvada P, Jayasurya R, Shankar V, Parameswaran S. Epidemiology and outcomes of acute kidney injury in critically ill: experience from a tertiary care center. Indian Journal of Nephrology. 2018;28(6):413.

Santos RPd, Carvalho ARS, Peres LAB, Ronco C, Macedo E. An epidemiologic overview of acute kidney injury in intensive care units. Revista da Associação Médica Brasileira. 2019;65:1094-101.

Jiang L, Zhu Y, Luo X, Wen Y, Du B, Wang M, et al. Epidemiology of acute kidney injury in intensive care units in Beijing: the multi-center BAKIT study. BMC nephrology. 2019;20:1-10.

Dos Santos RP, Carvalho ARdS, Peres LAB. Incidence and risk factors of acute kidney injury in critically ill patients from a single centre in Brazil: a retrospective cohort analysis. Scientific Reports. 2019;9(1):18141.

Forni L, Darmon M, Ostermann M, Oudemans-van Straaten H, Pettilä V, Prowle J, et al. Renal recovery after acute kidney injury. Intensive care medicine. 2017;43:855-66.

Rubin S, Orieux A, Clouzeau B, Rigothier C, Combe C, Gruson D, et al. The incidence of chronic kidney disease three years after non-severe acute kidney injury in critically ill patients: a single-center cohort study. Journal of Clinical Medicine. 2019;8(12):2215.

Ülger F, Pehlivanlar Küçük M, Küçük A, İlkaya N, Murat N, Bilgiç B, et al. Evaluation of acute kidney injury (AKI) with RIFLE, AKIN, CK, and KDIGO in critically ill trauma patients. European Journal of Trauma and Emergency Surgery. 2018;44:597-605.

Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Critical care. 2006;10(3):1-10.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical care. 2007;11:1-8.

Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice. 2012;120(4):c179-c84.

Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. Journal of the American Society of Nephrology: JASN. 2009;20(3):672.

Hashemian SM, Jamaati H, Bidgoli BF, Farrokhi FR, Malekmohammad M, Roozdar S, et al. Outcome of acute kidney injury in critical care unit, based on AKI network. Tanaffos. 2016;15(2):89.

Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clinical journal of the American Society of Nephrology: CJASN. 2014;9(1):12.

Hoste EA, Kellum JA, Selby NM, Zarbock A, Palevsky PM, Bagshaw SM, et al. Global epidemiology and outcomes of acute kidney injury. Nature Reviews Nephrology. 2018;14(10):607-25.

Xiong J, Tang X, Hu Z, Nie L, Wang Y, Zhao J. The RIFLE versus AKIN classification for incidence and mortality of acute kidney injury in critical ill patients: a meta-analysis. Scientific reports. 2015;5(1):17917.

Rodrigo E, Suberviola B, Albines Z, Castellanos Á, Heras M, Rodriguez-Borregán JC, et al. Comparación de los sistemas de clasificación del fracaso renal agudo en la sepsis. Nefrología (Madrid). 2016;36(5):530-4.

Koeze J, Keus F, Dieperink W, Van der Horst I, Zijlstra J, Van Meurs M. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC nephrology. 2017;18(1):1-9.

Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X, et al. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Critical care. 2014;18:1-8.

Jiang F, Chen Y, Liang X, Xu L, Ma G, Hu P, et al. The sensitivity and accuracy of RIFLE and AKIN criteria for acute kidney injury diagnosis in intensive care unit patients. Zhongguo wei zhong bing ji jiu yi xue= Chinese critical care medicine= Zhongguo weizhongbing jijiuyixue. 2011;23(12):759-62.

Allen JC, Gardner DS, Skinner H, Harvey D, Sharman A, Devonald MA. Definition of hourly urine output influences reported incidence and staging of acute kidney injury. BMC nephrology. 2020;21(1):1-8.

Ratanarat R, Skulratanasak P, Tangkawattanakul N, Hantaweepant C. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for predicting hospital mortality in critically ill patients with multi-organ dysfunction syndrome. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet. 2013;96:S224-31.

Macedo E, Malhotra R, Claure-Del Granado R, Fedullo P, Mehta RL. Defining urine output criterion for acute kidney injury in critically ill patients. Nephrology Dialysis Transplantation. 2011;26(2):509-15.

Yue J, Wu D, Li C, Zhai Q, Chen X, Ding S, et al. Use of the AKIN criteria to assess the incidence of acute renal injury, outcome and prognostic factors of ICU mortality in critically ill patients. Zhonghua yi xue za zhi. 2011;91(4):260-4.

Zhou J, Yang L, Zhang K, Liu Y, Fu P. Risk factors for the prognosis of acute kidney injury under the Acute Kidney Injury Network definition: a retrospective, multicenter study in critically ill patients. Nephrology. 2012;17(4):330-7.

Zhang Q, Fei Y, Jiang L. Risk factors for mortality in intensive care unit patients with sepsis combined with acute kidney injury after continuous renal replacement therapy: secondary analysis of the data from a multicenter observational study. Zhonghua wei Zhong Bing ji jiu yi xue. 2019;31(2):155-9.

Pinheiro KHE, Azêdo FA, Areco KCN, Laranja SMR. Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU. Brazilian Journal of Nephrology. 2019;41:462-71.

Papadimitriou-Olivgeris M, Assimakopoulos SF, Kolonitsiou F, Solomou A, Vamvakopoulou S, Spyropoulou A, et al. Risk factors for acute kidney injury in critically ill patients with bacteraemia by carbapenem non-susceptible Gram negative bacteria. Infez Med. 2019;27(4):380-92.

Montomoli J, Donati A, Ince C. Acute kidney injury and fluid resuscitation in septic patients: are we protecting the kidney? Nephron. 2019;143(3):170-3.

Ralib AM, Nanyan S, Ramly NF, Har LC, Cheng TC, Nor MBM. Acute kidney injury in Malaysian intensive care setting: incidences, risk factors, and outcome. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2018;22(12):831.

Zhang J, Crichton S, Dixon A, Seylanova N, Peng ZY, Ostermann M. Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis. Critical Care. 2019;23:1-10.

Oweis AO, Alshelleh SA. Incidence and outcomes of acute kidney injury in octogenarians in Jordan. BMC Research Notes. 2018;11(1):1-5.

Downloads

Published

2024-01-15

How to Cite

PERVAIZ , R., QAYYUM , M., KHALID , S., HAFEEZ , T., MUNAWAR , M., ARIF , H., KANDEEL , H., ELMASRY , W., & RAZA , S. (2024). A SINGLE-CENTER STUDY EVALUATING THE PREVALENCE, RISK FACTORS, AND CONSEQUENCES OF ACUTE KIDNEY INJURY IN THE INTENSIVE CARE UNIT. Pakistan Journal of Intensive Care Medicine, 4(01), 21. https://doi.org/10.54112/pjicm.v4i01.22

Issue

Section

Original Research Articles

Most read articles by the same author(s)

1 2 3 > >>