Clinical spectrum of hospital acquired acute kidney injury: A prospective study from Central India

Abstract

Acute kidney injury (AKI) is a common disorder worldwide that is associated with severe morbidity, mortality and cost. If managed adequately and in a timely manner, the majority of these cases are preventable, treatable and often reversible with simple measures. We conducted a two years prospective study of patients admitted to medical and surgical units of a tertiary care center in Central India to identify the causes of Hospital Acquired AKI (HAAKI) and its impact on patient outcomes. HAAKI occurred in 215 of 9,800 patients (2.1%). Sepsis (75; 34.88%), volume depletion and hypo perfusion (62; 28.83%), drugs (50; 23.25%), multifactorial (18; 8.37%) and radiocontrast agents (9; 4.2%) were the causes of HAAKI. Thirty-nine percent of patients had complete recovery and 9.3% had partial recovery of renal function. The overall inhospital mortality due to HAAKI was 41.86%. On multivariate analysis, oliguria, multi-organ failure, metabolic acidosis, anemia, and sepsis showed significant association with in-hospital mortality. The mortality and morbidity associated with HAAKI mandates the need for active measures to decrease its incidence. Knowledge of incidence and risk factors is crucial because it drives local and international efforts on detection and treatment. To the best of our knowledge, no epidemiological study has been conducted or published on HAAKI from the Central India.

A Comparative Study of Community Acquired Acute Kidney Injury with Hospital Acquired Acute Kidney Injury – A Hospital Based Study from North-East India

“…All these parameters indicate that overall outcome of patients is worse in HAAKI in comparison to CAAKI. This is in accordance with that of many other studies [13,18,23]. This higher mortality may be due to multiple co-morbidities present in hospitalised patients.…”

“…This variation in incidence of AKI may be as a result of the difference in standard of health care system, socioeconomic condition and educational status of the population. Males constituted the majority of patients in both the groups but there was no difference in age distribution as in a study by Goswami S et al, [13]. This male preponderance may be a reflection of the male dominating nature of our society exposing them to various environmental, occupational and social factors which can lead to AKI.…”

“…Out of the total 304 patients, 71.1% and 28.9 % of patients had CAAKI and HAAKI respectively which is quite in the range of previous studies [13][14][15]. In contrast, a study by Al-Homrany M et al, [16] found that 38% and 62% were CAAKI and HAAKI respectively.…”

“…We found that sepsis was the most common cause of AKI in CAAKI whereas drug-induced was the most common cause in HAAKI as in the previous studies. [13,22] Other studies by Al-Homrany M et al, [16] and Effa EE et al, [20] also found sepsis as most common cause of CAAKI whereas some other studies [13,14,21] found volume depletion as most common cause of CAAKI.…”

Clinical Characteristics of Hospitalized Patients with Drug-Induced Acute Kidney Injury and Associated Risk Factors: A Case-Control Study

“…In this case-control study, we identified the clinical features of patients hospitalized for D-AKI and its associated risk factors. With the help of the ADE-ASAS-2, alarm signals were triggered in 454 cases, and 302 patients were identified as having hospital-acquired AKI; among them, 115 patients (38.08%) were diagnosed with D-AKI, consistent with the results of previous studies [ 24 , 25 ]. To include more cases and improve the sensitivity, a lenient exclusion trigger was set; the positive alarm rate was triggered in 25.33% of cases, better reflecting the real-world characteristics of D-AKI.…”