Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

Abstract

BackgroundDespite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs) in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes.MethodsWe analysed the demographic, morbidity, treatment modality and outcome data of patients (n = 459) admitted to ICUs between October 1st, 2009 and November 30th, 2009 using a prospectively filled in electronic survey form in 7 representative ICUs.ResultsThe major reason for ICU admission was surgical in 64.3% of patients and medical in the remaining 35.7%. One-hundred-twelve patients (24.4%) had AKI. By AKIN criteria 11.5% had Stage 1, 5.4% had Stage 2 and 7.4% had Stage 3. In 44.0% of patients, AKI was associated with septic shock. Vasopressor treatment, SAPS II score, serum creatinine on ICU admission and sepsis were the independent risk factors for development of any stage of AKI. Among the Stage 3 patients (34) 50% received renal replacement therapy. The overall utilization of intermittent renal replacement therapy was high (64.8%). The overall in-hospital mortality rate of AKI was 49% (55/112). The ICU mortality rate was 39.3% (44/112). The independent risk factors for ICU mortality were age, mechanical ventilation, SOFA score and AKI Stage 3.ConclusionsFor the first time we have established the incidence of AKI using the AKIN criteria in Hungarian ICUs. Results of the present study confirm that AKI has a high incidence and is associated with high ICU and in-hospital mortality.

Acute Kidney Injury; Frequency in Hospitalized Patients

“…17 AKI was observed in 104 (27.2%) patients in our settings. Our results match with those of Coca et al 18 (26.6%) in American and Medve and Gondos 19 (24.4%) in Hungarian population. A much lower frequency of 10.8% has been reported by Cruz et al 20 among American population.…”

“…A similar insignificant difference (p=0.78) in the frequency of AKI across genders has been shown previously by Medve et al in Hungarian Population. 19 Our study is first of its kind in local population and provides baseline local statistical data about the frequency of AKI. We have also noted higher frequency of AKI and some factors in some particular disease at admission and some others in a different underlying medical condition which may help in identification of high risk patients and measures to reduce the risk of AKI in such patients by avoiding that particular factor in future practice.…”

Nursing Activities Score and Acute Kidney Injury

“…The period of MV use for patients with AKI was 4.7 days, whereas for those without AKI it was 2.4 days, which was without statistical significance. which showed values between 29.2% and 39.3% (21)(22) ; however, it was much higher when compared to patients who did not progress with ARF (7.5%). The profile of patients admitted to the ICU is generally associated with greater organ dysfunction, with the need for VAD, MV and RRT, which implies an increased risk of death.…”

Investigation of Mortality Predictors in General Intensive Care Unit Patients with Nosocomial Sepsis: A Retrospective Cohort Study

“…Thus, haemodialysis required for acute renal failure should be considered as a strong, independent risk factor for mortality, as is seen in our results. In elderly populations, there is increased susceptibility to drug toxicity, partially owing to altered drug pharmacokinetics and pharmacodynamics (18) . Prevention of septic acute renal failure may be possible by early diagnosis of advanced cases with sepsis encountered in ICUs.…”