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Kidney Week

Abstract: SA-PO536

AKI in a Developing Country: Clinical Course, Renal Recovery and Patient Outcome

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Subbiah, Arunkumar, All India Institute of Medical Sciences, New Delhi, India
  • Agarwal, Sanjay K., All India Institute of Medical Sciences, New Delhi, India
  • Bhowmik, Dipankar M., All India Institute of Medical Sciences, New Delhi, India
  • Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, India
  • Bagchi, Soumita, All India Institute of Medical Sciences, New Delhi, India
  • Yadav, Raj Kanwar, All India Institute of Medical Sciences, New Delhi, India
Background

Acute Kidney Injury (AKI) is an important determinant of outcome in hospitalized patients. Moreover, there is a risk for future development of Chronic Kidney Disease (CKD). Though the long-term impact of AKI has been studied in developed countries, there is a paucity of data in this area from the Indian subcontinent. This single-centre study aimed to assess the pattern, clinical spectrum and long-term outcome of AKI.

Methods

In this prospective observational cohort study, detailed demographic and clinical data at presentation, during hospital stay and follow-up at 1, 3, 6 and 12 months after discharge were obtained prospectively for a cohort of patients with AKI. Both community (CAAKI) and hospital acquired AKI (HAAKI) were included. Patient with preexisting CKD were excluded. Outcome variables were in-hospital mortality, renal function at discharge and on long-term follow-up.

Results

Of the 476 patients, majority of the cases, 395 (83%) were CAAKI. The mean age was 44.8 ± 18.7 years. Etiology groups included medical (84%), surgical (10%) and obstetric (6%) with sepsis (176/476; 36.9%) being the most common cause of AKI. The in-hospital mortality rate was 38%. Age >60 yrs (HR = 1.51; 95% CI, 1.11 – 2.07), oliguria (HR = 1.48; 95% CI, 1.05 – 2.10) and need for ventilator (HR = 2.45; 95% CI, 1.36 – 4.41) and/or inotropes (HR = 14.4; 95% CI, 6.28 – 33.05) were predictors of mortality. At discharge, 146 (30.7%) patients had complete renal recovery, while 149 (31.3%) had partial renal recovery. Oliguria (p < 0.001), hypoalbuminaemia (p = 0.001) and need for renal replacement therapy (RRT) (p = 0.01) were significantly associated with partial recovery. Of the 295 patients on follow-up, 211 (71.5%) patients had normal renal function, 4 (1.4%) died and 33 (11.2%) lost to follow up; 41(14%) patients developed CKD while 6 (2%) were dialysis dependent. The need for RRT during hospital stay was the single most important factor predicting the risk of CKD (OR 1.77, 95% CI, 1.12-2.78).

Conclusion

In conclusion, our data shows that AKI in hospitalized patients still has high mortality. Though a fairly good percentage of cases recovered, there is a definite risk of CKD development, especially in patients who required RRT during hospitalization.