Acute kidney injury in dengue fever using Acute Kidney Injury Network criteria: incidence and risk factors

Abstract

The aim of this study was to assess incidence and risk factors for acute kidney injury (AKI) in patients with dengue fever (DF). A total of 223 patients (males, 130; females, 93; mean age, 26.2 ± 18.2 years) from a tertiary care centre in southern India were retrospectively analysed. Acute renal failure (ARF) developed in 24 (10.8%) patients. Based on the Acute Kidney Injury Network (AKIN) criteria, the results revealed that: 12 (5.4%) had mild AKI; seven (3.1%) had moderate AKI; and five (2.2%) had severe AKI. A further 54 (24%) were diagnosed with dengue haemorrhagic fever (DHF); 11 (5%) were co-infected with leptospirosis; thrombocytopenia was present in 157 (70%); and 64 (29%) were hypotensive. Patients were divided into either group A (with AKI) or group B (without AKI), and group A was divided into mild (A1), moderate (A2) and severe (A3) subgroups. We recorded: a higher total white count (A = 9824; B = 6706; P = 0.01); serum glutamic pyruvic transaminase (SGPT; A = 450; B = 144; P = 0.001); alkaline phosphatase (ALP) levels (A = 207; B = 42; P = 0.001); lower albumin (A = 2.65; B = 3.09; P < 0.001); and serum bicarbonate (A = 20.57; B = 23.21; P = 0.009). Hypotension (P = 0.01), coexisting viral hepatitis (P < 0.001), sepsis (P < 0.001), multiple organ dysfunction syndrome (MODS; P < 0.001) and the need for inotropes (P < 0.001) were associated with DF. Total white count (P = 0.038), glomerular filtration rate (GFR) on discharge (P = 0.034), specific gravity of urine (P = 0.006), ALP (P = 0.013), SGPT (P = 0.042), MODS (P = 0.05) and use of platelet fresh frozen plasma (FFP; P = 0.007) were significantly different between mild, moderate and severe AKI subgroups. Twenty-two (9%) died. AKI is associated with an increased mortality in DF (P = 0.005).

Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): a comparative analysis

“…In this regard, when the AKIN classification was evaluated, the incidence of AKI ranged from 10.8% to 13.3%5 6 while, with CD, the incidence varied between 0.9% and 3.3% 3 4. We found two studies evaluating the incidence of AKI using the RIFLE criteria that reported a much higher incidence than our study 13 14.…”

“…The probability of developing AKI in dengue infection varies from 0.9% to 13.3% according to the diagnostic criteria adopted and the severity of the dengue infection—that is, dengue fever (DF), dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS) 3–6. The reported incidence of AKI is 0.9%3 and 3.3%4 in DHF/DSS, while the incidence of AKI has been reported to be 10.8%5 and 13.3%6 in all types of dengue infection, irrespective of severity. The development of AKI has a significant impact on the outcome of patients with dengue infection, with mortality estimated at 11.3–64% and a longer hospital stay 3 4 6.…”

“…To date, AKI in dengue infection has been defined by a conventional definition (CD) (SCr >2 mg/dL),3 4 the AKIN5 6 or RIFLE13 14 classifications, but the rapidly fluctuating incidence of AKI in dengue infection from 0.9%3 to 13.3%6 indicates an urgent need for consensus in identifying AKI in dengue infection. Moreover, the RIFLE classification has not been properly validated in patients with dengue.…”

Spectrum of Acute Kidney Injury and its Outcome in Intensive Care Unit in Tertiary Care Center in India

“…Emerging data suggest hospital survivors of critical illness complicated by AKI have a greater than threefold increased risk for end stage kidney disease (ESKD) over the subsequent decade when compared with matched controls (10). Incomplete or partial recovery of kidney function following AKI is likely to become an increasingly recognized problem, and data suggest these patients also have a lower rate of survival and a higher risk of progression to ESKD (11,12). In our study, recovery of renal function was noted in 85% of patients.…”

“…Acute cardiorenal syndrome where in Acute cardiogenic shock and acutely decompensated congestive heart failure leads to acute kidney injury was the fourth (12.3%) leading cause of AKI in our study. Dengue fever related AKI comprise 10.8% of AKI in a recent study from south India (12). In our study population, Denguerelated AKI contributed to 6.2% of the cases.…”