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Kidney Week

Abstract: PO0223

Risk Factors for AKI in the Intensive Care Unit

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Da Silva Lugo, Ian J., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Colon Nunez, Carla I., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Miranda, Eric, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Ocasio Melendez, Ileana E., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
Background

Acute Kidney Injury (AKI) is defined by a sudden decrease in glomerular filtration rate. It currently represents a global public health issue as it is associated with short and long-term morbidity and mortality. In the Intensive Care Unit (ICU) there is an overall incidence of AKI ranging from 20-50% and a mortality rate from 15-60%. Its development leads to increased length of stay and costs. The main objective of this proposed study is to identify risk factors associated with the development of acute kidney injury in a community hospital and a tertiary hospital in Puerto Rico. Also, to investigate if there is a relationship between AKI, length of stay and mortality.

Methods

This retrospective case control study included patients 18 years of age or older admitted to the ICU between January 2015 to December 2016. Patients with chronic kidney disease (CKD) stage 4 or 5, maintenance renal replacement therapy (RRT), or AKI before ICU admission were excluded. The population was divided between patients with AKI and patients without AKI. AKI was diagnosed according to KDIGO criteria. Demographic (age, gender) and clinical data (comorbid conditions, APACHE II score, sepsis or septic shock, vasopressors status, mechanical ventilation, creatinine levels, urine output, nephrotoxic drugs, RRT use, and mortality) was collected from medical records.

Results

Among 121 patients included (median age 54.40, 50% male), 44.6% were diagnosed with AKI and 3.31% underwent RRT. All 7 patients with diagnosed Chronic Obstructive Pulmonary Disease (COPD) had AKI during ICU stay (p-value 0.0024). Diuretics, aminoglycosides, and amphotericin B had a statistically significant relationship with AKI (p-value 0.012, 0.002, and 0.050 respectively). Mechanical ventilation, vasopressor use, sepsis or septic shock and mortality also had a statistically significant relationship with AKI (p-value 0.013, 0.002, 0.018 and <0.0001 respectively).

Conclusion

In our study AKI had a statistically significant association with COPD, diuretics, aminoglycosides, amphotericin B, mechanical ventilation, vasopressors, sepsis or septic shock and mortality. Nephrotoxic agents described as statistically significant are modifiable risk factors to be considered in their administration. This study aids in the characterization of an epidemiologic pattern on ICU patients for future applicability.