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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 4  |  Page : 813-815
Clinical characteristics and outcomes of patients with acute kidney injury: A single-center study


430, Danny Hettiarachchi Mawatha, Kaduwela Road, Battaramulla, Sri Lanka

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Date of Web Publication24-Jun-2013
 

How to cite this article:
Rathnamalala N. Clinical characteristics and outcomes of patients with acute kidney injury: A single-center study. Saudi J Kidney Dis Transpl 2013;24:813-5

How to cite this URL:
Rathnamalala N. Clinical characteristics and outcomes of patients with acute kidney injury: A single-center study. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 21];24:813-5. Available from: http://www.sjkdt.org/text.asp?2013/24/4/813/113903
To the Editor,

Acute kidney injury (AKI) is a cause of considerable morbidity and mortality among hospitalized patients. [1],[2],[3] It presents with a spectrum of severity and is an important cause of persistent renal dysfunction. [4],[5] The spectrum of the disease has now been defined with the use of two classification systems: Risk Injury Failure Loss End-Stage Renal Failure (RIFLE) criteria and Acute Kidney Injury Network (AKIN) criteria. [6],[7]

The use of these classification systems has made a uniform diagnosis possible. The incidence and demographic patterns of AKI in Sri Lanka are largely unknown due to the lack of published data. Studies elsewhere have shown a dominance of advanced age and co-morbid disease among patients with AKI, with more than 50% requiring renal replacement therapy (RRT). [3],[8],[9]

We conducted a cross-sectional study on patients referred for nephrology care over a period of four months. Data from the enrolled patients were extracted from their medical records using a data sheet. We defined AKI according to the RIFLE classification using both the urine output and the serum creatinine criteria. [6] Baseline renal function was defined as the lowest serum creatinine (SCr) value within the past three months as seen in the medical records. For patients whose previous value was not available, the baseline SCr was estimated by solving the Modification of Diet in Renal Disease (MDRD) equation, assuming a glomerular filtration rate of 75 mL/min/1.73 m 2 as recommended by the Acute Dialysis Quality Initiative (ADQI) Working Group. [6] Sepsis was defined according to the definitions of the American College of Chest Physicians/ Society of Critical Care Medicine. [10]

Outcomes were measured as complete recovery when the patients' SCr level dropped within 120% of baseline on discharge; partial recovery if SCr at discharge was 121-150% of baseline; and non-recovery if SCr at discharge was greater than 150% of baseline or if the patient was still receiving RRT. [11]

We enrolled 68 patients over a period of four months. The patient characteristics are shown in [Table 1]. The mean age was 49 years (±17.6), 73.5% were males, the mean body mass index (BMI) was 20.26 and 50% of the study population had pre-existing co-morbid disease. The etiologies identified among the participants are shown in [Table 2].
Table 1: Distribution of patient characteristics

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Table 2: Distribution of patients by etiology.

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Sepsis (41.2%) was the most common cause for AKI and leptospirosis (29.4%) was the second most common cause for the same. The various sources of sepsis are shown in [Figure 1]. The source was largely unidentified, but urinary tract infection was the leading cause among those that were identified.
Figure 1: Sources of sepsis among patients.

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Fifty-eight patients (85.3%) required RRT, with 46 patients (79.32%) receiving hemodialysis and 12 patients (20.68%) receiving acute peritoneal dialysis. Twenty patients (29.4%) made complete recovery while 28 patients (41.2%) made partial recovery; the mortality rate was 24%. Of the patients who made complete recovery, 70% were below the age of 55 years compared with 30% who were over 55 years (P = 0.13). The presence of co-morbidities was associated with a worse outcome, with only 5.9% patients achieving complete recovery (P < 0.01). None of the patients with pre-morbid diabetes mellitus made a complete recovery (P <0.01).

The finding of sepsis being the most common cause of AKI in our study is in keeping with many other studies. [3],[12],[13] Additionally, many studies have also shown a linear relationship between the severity of sepsis and the outcome of AKI. [14] In our study, the presence of co-morbidities such as diabetes mellitus and hypertension was associated with a poor outcome. Among our study population, 50% had preexisting co-morbid diseases while higher rates have been reported elsewhere. These studies also observed a poorer outcome in those with associated co-morbidity. [3],[13],[15]

Chances of complete recovery were less in patients with advanced age. Epidemiological studies show that the incidence of AKI is higher among the elderly and that these patients carry a higher incidence of occurrence of ESRD as well as higher mortality following AKI. [16] Aging kidneys undergo structural and functional changes that decrease their auto-regulatory capacity, which may explain the higher incidence in the elderly. [17] They may have undetected underlying chronic kidney disease, which may make them more susceptible to further damage and may explain why SCr, which is used as the marker to assess recovery, may not fall within the expected limits.

Our study suggests that sepsis remains the most common cause of AKI and leptospirosis remains an important cause of AKI in Sri Lanka. Older age and the presence of co-morbidities predicted a poorer outcome.

 
   References Top

1.Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. J Am Med Assoc 2005;294:813-8.  Back to cited text no. 1
    
2.Hoste EA, Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care Med 2006;34:2016-7.  Back to cited text no. 2
    
3.Ali T. Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: A comprehensive population-based study. J Am Soc Nephrol 2007;18:1292-8.  Back to cited text no. 3
    
4.Palevsky PM, Zhang JH,O' Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7-20.  Back to cited text no. 4
    
5.Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med 1995; 155:1505-11.  Back to cited text no. 5
    
6.Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative work group. Acute Renal failure- definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:204-12.  Back to cited text no. 6
    
7.Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.  Back to cited text no. 7
    
8.Wan L, Bagshaw SM, Langenberg C, et al. Pathophysiology of septic acute kidney injury: What do we really know? Crit Care Med 2008;36:S198-203.  Back to cited text no. 8
    
9.Langenberg C, Wan L, Egi M, May CN, Bellomo R. Renal blood flow in experimental septic acute renal failure. Kidney Int 2006;69: 1996-2002.  Back to cited text no. 9
    
10.Levy MM, Flink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6.  Back to cited text no. 10
    
11.Garzotti F, Piccinni P. Cruz D, et al. RIFLE based data collection/management system applied to a prospective cohort multicentre Italian study on the epidemiology of acute kidney injury in the intensive care unit. Blood Purif 2011;31:159-71.  Back to cited text no. 11
    
12.Bagshaw SM, Uchino S, Bellomo R, et al. Septic Acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2:431-9.  Back to cited text no. 12
    
13.James MT, Wald R, Bell CM, et al. Weekend Hospital Admission, Acute Kidney Injury and Mortality. J Am Soc Nephrol 2010;21:845-51.  Back to cited text no. 13
    
14.Ricci Z, Polito A, Ronco C. The implications and management of septic acute kidney injury. Nat Rev Nephrol 2011;7:218-25.  Back to cited text no. 14
    
15.Stevens PE, Tamimi NA, Al-Hasani MK, et al. Non-specialist management of acute renal failure. QJM 2001;94:533-40.  Back to cited text no. 15
    
16.Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of end stage renal disease among elderly. J Am Soc Nephrol 2009;20:223-8.  Back to cited text no. 16
    
17.Anderson S, Eldadah B, Halter JB, et al. Acute kidney injury in older adults. J Am Soc Nephrol 2011;22:28-38.  Back to cited text no. 17
    

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Correspondence Address:
Nadeeka Rathnamalala
430, Danny Hettiarachchi Mawatha, Kaduwela Road, Battaramulla
Sri Lanka
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DOI: 10.4103/1319-2442.113903

PMID: 23816740

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