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Abstract: PO0200

Community-Acquired AKI: A Prospective Case-Control Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Ragnarsdóttir, Telma Huld, Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Kristjansdottir, Margret, Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Gislason, Gisli, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  • Sanchez-Brunete, Vicente, Department of Emergency Medicine, Landspitali–the National University Hospital of Iceland, Reykjavik, Iceland
  • Tomasdottir, Margret Olafia, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  • Samuelsson, Olafur Helgi, Department of Geriatric Medicine, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Palsson, Runolfur, Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Indridason, Olafur S., Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
Background

Acute kidney injury (AKI) represents an abrupt decline in kidney function occurring over hours or days. While hospital-acquired AKI has been extensively studied, data on community-acquired AKI are scarce. The aim of this study was to examine the incidence and causes of AKI among patients presenting to the emergency department (ED).

Methods

This was a prospective case-control study in which serum creatinine (SCr) of all individuals admitted to the ED of Landspitali–The National University Hospital were examined for the presence of AKI. We present data from January 1 until March 3, 2020 and May 19 until September 21, 2020. The study was paused between these periods due to the COVID-19 epidemic. All patients who met the KDIGO criteria for AKI were invited to participate. Randomly selected control cases (1:2) were paired according to age, sex and time of ED admission. Participants answered questions about their medical history and use of medications, including over-the-counter (OTC) drugs. Medical records were reviewed with regard to medical history. Logistic regression was used to identify factors associating with AKI.

Results

A total of 372 persons with AKI were identified, 315 (85%) of whom participated in the study. The mean (±SD) age of AKI cases and controls was 66.6±16.1 years and 66.3±16.2 years, respectively; 46% of cases and controls were female. AKI cases were significantly more likely than controls to have used non-steroidal anti-inflammatory drugs (NSAIDs) (31.1% vs 22.2%, p=0,003) in the week preceding the ED visit, particularly OTC NSAIDs (24.7% vs 16.2%, p=0.001). In the logistic regression analysis, AKI was associated with vomiting (OR 2.40 95%CI 1.74-3.35), diarrhea (OR 1.35, 95%CI 1.00-1.84), diabetes (OR 1.66, 95%CI 1,17-2,35) and NSAID use (OR 1.60, 95%CI 1.18-2.23), but a statistically significant relationship was not observed for use of ACE inhibitors/angiotensin receptor blockers or diuretics, or a history of hypertension, vascular disease or chronic kidney disease.

Conclusion

These results suggest that volume depletion and the use of NSAIDs play a major role in the development of AKI in the community setting. Frequent use of OTC NSAIDs is a concern and should be addressed in light of serious adverse effects.

Funding

  • Government Support – Non-U.S.