Kidney Week

Abstract: SA-PO536

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

Session Information

• AKI: Clinical, Outcomes, Trials - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Subbiah, Arunkumar, All India Institute of Medical Sciences, New Delhi, India

Arunkumar Subbiah,

• Agarwal, Sanjay K., All India Institute of Medical Sciences, New Delhi, India

Sanjay K. Agarwal,

• Bhowmik, Dipankar M., All India Institute of Medical Sciences, New Delhi, India

Dipankar M. Bhowmik,

• Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, India

Sandeep Mahajan,

• Bagchi, Soumita, All India Institute of Medical Sciences, New Delhi, India

Soumita Bagchi,

• Yadav, Raj Kanwar, All India Institute of Medical Sciences, New Delhi, India

Raj Kanwar Yadav,

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.