CLINICAL ACUTE KIDNEY INJURY 1
Ravi Mahajan
Serigne Lo2014, Nephrology Dialysis Transplantation
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Abstract
Introduction and Aims: Acute kidney injury (AKI) is an important public health problem. AKI is a risk factor for progression of kidney disease, incidence of chronic kidney disease (CKD) and mortality. The aim of the study was to assess characteristics, renal survival and mortality of patients who developed AKI stage 3, according to KDIGO guidelines, and needed renal replacement therapy (RRT), not in intensive care unit. Methods: All patients who required RRT due to AKI stage 3 along two years were included, excluding patients in intensive care unit. Demographic and personal history data, previous renal function, cause of AKI, renal function, renal survival, and mortality at one, three, six and twelve months after AKI were recorded. Results: A total of 107 patients were enrolled (incidence 134 patients/106 population/ year). Mean age 72.2±13.9 (range 25-92), 57.9% men. Patient's characteristics: 77.6% were hypertensive, 40.2% were diabetics, 45.8% were dyslipemics, 41.1% were obese, 27.1% were smokers, and 61.2% with chronic renal failure (eFG<60mil/min) of which 54% stage 3, 36.5% stage 4, and 9.5% stage 5. Cause of AKI: renal disease 63.6%, prerrenal 28.9% and obstructive causes 7.5%.Renal function: Serum creatinine before AKI 1.78±1.12 mg/dL; maximum serum creatinine during AKI hospitalization 7.39 ±4.43mg/dL; at discharge, 2.64±1.62mg/dL; one month later, 2.07±1.36mg/dL; three months later, 2.35±1.60mg/dL; six months later, 2.25±1.85mg/dL and one year later, 1.95±1.14 mg/dL.During hospitalization, 24.3% died, 16.8% kept on RRT at discharge, and 58.9% recovered partial or completely renal function. One month after AKI, 31.7% had died, 15.8% kept on RRT, and 52.5% preserved renal function, 5.6% was missing. Three months later, 45.7% died, 10.9% kept on RRT, and 43.5% preserved renal function, 14% was missing. Six months later, 48.3% had die, 10% kept on RRT, and 33.3% preserved renal function, 8.3% were missing. Finally, one year after AKI, 71.8% of patients had died, 9.9% needed RRT, 18.3% recovered partial or completely renal function and 33.6% missing. AKI in diabetic or dyslipemic patients has an increased mortality ( p=0.03 and p=0.06 respectively). CKD before AKI is not associated with increased mortality.Renal function according to KDOQI classification of patients who had AKI stage 3 was: at discharge: stage 1 1.6%, 2 16.1%, 3 24.2%, 4 37.1% and 5 21.0%; three months after AKI : stage 1 2.5%, 2 15%, 3 30%, 4 32.5% and 5 17.5%; six months after AKI: 1 6.5%, 2 12.9%, 3 38.7%, 4 19.4% and 5 19.4% and one year after AKI, renal function was: 2 25%, 3 41.7%, 4 25% and 5 8.3%. Conclusions: In our health area AKI stage 3 requiring RRT have a incidence similar to other studies. Mortality in AKI patients exceeds 70% one year after AKI episode and renal survival decreases in this period. Nephrology follow-up must be established in patients who survive AKI. The develop of tools to identify high-risk patients and to promote renal recovery is important to reduce burden of CKD and mortality.
