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Kidney Week

Abstract: PO0205

AKI in Kuwait: Incidence, Causes, Management, and Outcomes – A Prospective Observational Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • AlSahow, Ali, Al Jahra Hospital, Al Jahra, Al Jahra, Kuwait
  • Al Yousef, Anas M., Amiri Hospital, Kuwait City, Kuwait, Kuwait
  • Alhelal, Bassam A., Al Adan Hospital, Kuwait, Al Asimah, Kuwait
  • Al Rajab, Heba, Farwaniya Hospital, Farwaniya, Farwaniya, Kuwait
  • Alqallaf, Ahmed, Jaber Al Ahmed Al Jaber Al Sabah Hospital, Surra, Kuwait
  • Bahbahani, Yousif, Mubarak Al-Kabeer Hospital, Safat, Kuwait
  • Alsharekh, Monther M A M H, Chest Diseases Hospital, Kuwait, Al Asimah, Kuwait
  • Said, Basem, Al Jahra Hospital, Al Jahra, Al Jahra, Kuwait
  • Osman, Mohamed Abdellatif, Farwaniya Hospital, Farwaniya, Farwaniya, Kuwait
  • Mazroue, Ahmed Mohamed, Amiri Hospital, Kuwait City, Kuwait, Kuwait
  • Abdelzaher, Ali Salah, Chest Diseases Hospital, Kuwait, Al Asimah, Kuwait
  • Abdelmoteleb, Alaa Tolba, Jaber Al Ahmed Al Jaber Al Sabah Hospital, Surra, Kuwait
  • Nessim, Gamal, Mubarak Al-Kabeer Hospital, Safat, Kuwait
  • Abdallah, Emad, Al Adan Hospital, Kuwait, Al Asimah, Kuwait
  • Malhotra, Rajeev Kumar, All India Institute of Medical Sciences, New Delhi, Delhi, India
Background

Little is known about AKI epidemiology, causes, management and outcome in Kuwait. We report that.

Methods

Demographics, comorbidities, treatment and 4 weeks outcome data for nephrology referrals for AKI in 7 public hospitals from 1/Jan-30/Apr/2021 prospectively collected and analyzed

Results

Total number of AKI referrals was 1298, that is 3.3% of hospital admissions. Community acquired cases were 12.5%. Males were 57%, mean age 64 (52% > 65), and Kuwaiti citizens 65%. DM affected 71%, HTN 74%, and cardiac disease 36% of patients. Mean baseline eGFR before AKI was 62. Baseline eGFR < 60 seen in 52%, and those compared to patients with eGFR > 60, had mean baseline eGFR of 35 (vs 90), were older (68 vs 60 with 61% above age 65 vs 41%), 81% had DM (vs 60%), 85% had HTN (vs 63%), 46% had cardiac disease (vs 24%). Cause of AKI was pre-renal / ischemic ATN in 87%, COVID-19 related in 8%, contrast-associated in 6%, drug-induced AIN in 5% of cases. Many had more than one possible cause. Sepsis was most common precipitating factor seen in 67% then volume depletion in 50%. Many had more than one factor. IV fluids used in 73% (less in lower eGFR group), IV diuretics in 46% (more in lower eGFR group), IV vasopressors in 40% (less in lower eGFR group) and steroids in 33%. KRT needed in 33%, more in patients who used diuretics or vasopressors. Volume overload and electrolytes / acid-base disorders were most common indication (75% and 79% respectively). CKRT was modality of choice in 85%, however, in 52% of CKRT, conventional HD not used due to lack of dialysate source in some sites. At 30 days, mean eGFR was 42%, with complete recovery in 34%, and 38% failed to recover at all. Death occurred in 31%, 55% had baseline eGFR > 60, and 50% of deaths occurred while still on KRT. Non-survivors were older and had higher use of vasopressors. AKI associated mortality in 25% of total hospital mortality and in 31% of ICU / CCU mortality.

Conclusion

AKI is common. Most cases hospital-acquired. Use of resources (medications, critical care, KRT) and rates of mortality are high. Kuwaiti citizens represent 1/3 of the population and 2/3 of AKI cases and almost 70% of deaths.