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Abstract: FR-PO117

Epidemiology and Outcome of Community- and Hospital-Acquired AKI in a Developing Country

Session Information

  • AKI: Outcomes, RRT
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania 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, Delhi, India
  • Agarwal, Sanjay K., All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Yadav, Raj Kanwar, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Bagchi, Soumita, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Bhowmik, Dipankar M., All India Institute of Medical Sciences, New Delhi, Delhi, India
Background

Acute Kidney Injury (AKI) is associated with adverse short-term and long-term outcomes in hospitalized patients. In developing countries, including India, Community acquired AKI (CAAKI) is more common than hospital acquired AKI (HAAKI) and the pattern varies with different geographical areas. This single-centre study aimed to assess the clinical spectrum, risk factors for in-patient mortality and renal outcome of patients with CAAKI compared to HAAKI.

Methods

In this prospective observational cohort study conducted in a tertiary care hospital in India, hospitalized patients with AKI were enrolled and followed-up for upto 12 months after discharge. Patients with renal dysfunction at admission or worsening renal dysfunction in the first 48 hrs of hospitalization were classified as having CAAKI while patients with renal dysfunction after 48 hours of hospitalization were classified as HAAKI. Outcome variables were in-hospital all-cause mortality, renal function (by creatinine) at discharge and on long-term.

Results

A total of 476 AKI patients were enrolled in this study; 395 (83%) were CAAKI. The mean age was 44.8±18.7 years. Sepsis (176/476; 36.9%) was the most common cause of AKI. The in-hospital mortality was 38%. The peak serum urea and creatinine was higher in patients with CAAKI than HAAKI. The need for ventilator (34.9% vs 67.9%), inotropic support (38% vs 73%) and in-hospital mortality (31% vs 73%) was more in HAAKI. Patients with HAAKI had significantly higher mortality (72% vs 31%). Age >60 yrs (HR=1.51; 95% CI,1.11–2.07), oliguria (HR=1.48; 1.05–2.10), need for ventilator (HR=2.45; 1.36–4.41) and/or inotropes (HR = 14.4; 6.28–33.05) were predictors of in-hospital mortality. Of the 295 patients discharged, 146 (30.7%) had complete renal recovery, while 149 (31.3%) had partial renal recovery. Of the 295 patients on follow-up, 211 (71.5%) patients had normal renal function, 4 (1.4%) died and 41(14%) developed CKD while 6 (2%) were dialysis dependent. All patients having CKD on follow-up were patients of CAAKI group.

Conclusion

Present cohort study with long follow-up showed that there is a definite risk of CKD in recovered patients and they should be monitored periodically. AKI in hspitalized patients still has high mortality especially in patients with HAAKI.