Pos-019 Acute Kidney Injury in Oncology and Tumor Lysis Syndrome

Abstract

Introduction: Community-acquired acute kidney injury (AKI) is common, but often unrecognized in resource-constrained settings. Limited lab assessments and lack of information on the prior state of kidney health contribute to this lack of recognition. In this study, we evaluated the cause of AKI in patients in whom AKI was suspected and then verified at initial presentation with point-of-care (POC) serum creatinine (sCr) testing. Methods: Patients presenting at participating community health care centers and emergency departments in Nepal, Bolivia, South Africa or Brazil with symptoms or signs associated with high/moderate risk of developing kidney disease underwent sCr POC testing. Staff at these centers were trained in the use of the POCs and also in the evaluation and management of kidney disease. Patient demographics and most likely etiology of acute kidney injury according to treating clinician judgment on presentation were recorded. Local practitioners determined if patients were to be treated locally or transferred to referral centers for more specialist management. Management was recorded as well as kidney and patient outcomes at discharge and over follow-up of up to 90 days after discharge. Results: 4319 patients were screened, and 4242 (98.2%) were enrolled (2028 Nepal, 858 Bolivia, 1173 South Africa and 183 Brazil). The screening form was completed in 4236 patients, with patient assessments 1 -3 completed in 4099, 3788 and 2432 cases respectively. Median (IQR) sCr at initial presentation was 1.40 (1.0-1.9) mg/dl and median (IQR) highest sCr during the episode was 1.43 (1.0-2.0) mg/dl. The most likely cause of kidney disease was documented in 3734 (88%) patients (Table ).The most common etiologies of AKI were infection (36.5% of cases) and hypovolaemia (18.2% of cases). Animal/insect bites caused 15.3% of cases in Brazil. The most common sites of infection causing AKI included the GI tract (35.2%), the lungs (18.2%) and the urinary tract (40.4%) in the cohort overall. Conclusions: Education of local healthcare workers twinned with the use of POC SCr testing facilitated the identification of kidney disease and its aetiology in four low-resource settings. Supporting previous data, the most common causes of kidney disease were infection and hypovolaemia, and hence AKI may be preventable and treatable with relatively simple interventions in this part of the world.