Risk, Predictors, and Outcomes of Acute Kidney Injury in Patients Admitted to Intensive Care Units in Egypt

Samar Abd ElHafeez, Giovanni Tripepi, Robert Quinn, Yasmine Naga, Sherif Abdelmonem, Mohamed AbdelHady, Ping Liu, Matthew James, Carmine Zoccali, Pietro Ravani, Samar Abd ElHafeez, Giovanni Tripepi, Robert Quinn, Yasmine Naga, Sherif Abdelmonem, Mohamed AbdelHady, Ping Liu, Matthew James, Carmine Zoccali, Pietro Ravani

Abstract

Epidemiology of acute kidney injury (AKI) in developing countries is under-studied. We evaluated the risk and prognosis of AKI in patients admitted to intensive care units (ICUs) in Egypt. We recruited consecutive adults admitted to ICUs in Alexandria Teaching Hospitals over six months. We used the KDIGO criteria for AKI. We followed participants until the earliest of ICU discharge, death, day 30 from entry or study end. Of the 532 participants (median age 45 (Interquartile range [IQR]: 30-62) years, 41.7% male, 23.7% diabetics), 39.6% had AKI at ICU admission and 37.4% developed AKI after 24 hours of ICU admission. Previous need of diuretics, sepsis and low education were associated with AKI at ICU admission; APACHE II score independently predicted AKI after ICU admission. A total of 120 (22.6%) patients died during 30-day follow-up. Compared to patients who remained AKI-free, mortality was significantly higher in patients who had AKI at study entry (Hazard Ratio [HR] 2.14; 95% Confidence Interval [CI] 1.02-4.48) or developed AKI in ICU (HR 2.74; 95% CI 1.45-5.17). The risk of AKI is high in critically ill people and predicts poor outcomes. Further studies are needed to estimate the burden of AKI among patients before ICU admission.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the study cohort.
Figure 2
Figure 2
Etiology of AKI by timing of diagnosis: at ICU and after ICU admission.
Figure 3
Figure 3
Predictors of 30-day mortality among ICU patients.
Figure 4
Figure 4
Different outcomes among the study cohort. AKI at ICU admission indicates people diagnosed with acute kidney injury (AKI) when they were admitted to intensive care unit (ICU); AKI after ICU admission indicates people who were AKI free when they were admitted but developed AKI during the study; AKI-free indicates people who remained AKI-free during the study. Hospital stay refers to the need to remain in the hospital beyond 30 days from ICU entry or transfer to another non-ICU unit. Death refers to 30 days mortality. Renal recovery is considered when the last available creatinine on ICU admission fell within 0.3 mg/dl or 50% of the baseline value, without requirements for renal replacement therapy.

References

    1. Lameire NH, et al. Acute kidney injury: an increasing global concern. Lancet. 2013;382:170–179. doi: 10.1016/S0140-6736(13)60647-9.
    1. Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney international. 2013;84:457–467. doi: 10.1038/ki.2013.153.
    1. Susantitaphong P, et al. World incidence of AKI: a meta-analysis. Clinical Journal of the American Society of Nephrology. 2013;8:1482–1493. doi: 10.2215/CJN.00710113.
    1. Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney international. 2012;81:819–825. doi: 10.1038/ki.2011.339.
    1. Santos PR, Monteiro DLS. Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study. BMC nephrology. 2015;16:1. doi: 10.1186/s12882-015-0026-4.
    1. Kane-Gill SL, et al. Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2015;65:860–869. doi: 10.1053/j.ajkd.2014.10.018.
    1. Hoste EA, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive care medicine. 2015;41:1411–1423. doi: 10.1007/s00134-015-3934-7.
    1. Linder A, et al. Small acute increases in serum creatinine are associated with decreased long-term survival in the critically ill. Am J Respir Crit Care Med. 2014;189:1075–1081. doi: 10.1164/rccm.201311-2097OC.
    1. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012;380:756–766. doi: 10.1016/S0140-6736(11)61454-2.
    1. Murugan R, Kellum JA. Acute kidney injury: what’s the prognosis? Nat Rev Nephrol. 2011;7:209–217. doi: 10.1038/nrneph.2011.13.
    1. Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014;371:58–66. doi: 10.1056/NEJMra1214243.
    1. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365–3370. doi: 10.1681/ASN.2004090740.
    1. Cerda J, Bagga A, Kher V, Chakravarthi RM. The contrasting characteristics of acute kidney injury in developed and developing countries. Nature clinical practice. Nephrology. 2008;4:138–153. doi: 10.1038/ncpneph0722.
    1. Ponce D, Balbi A. Acute kidney injury: risk factors and management challenges in developing countries. International Journal of Nephrology and Renovascular Disease. 2016;9:193. doi: 10.2147/IJNRD.S104209.
    1. Mehta RL, et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015;385:2616–2643. doi: 10.1016/S0140-6736(15)60126-X.
    1. Mehta RL, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. The Lancet. 2016;387:2017–2025. doi: 10.1016/S0140-6736(16)30240-9.
    1. Case, J., Khan, S., Khalid, R. & Khan, A. Epidemiology of acute kidney injury in the intensive care unit. Critical care research and practice2013 (2013).
    1. Ostermann, M. & Chang, R. W. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med35, 1837-1843; quiz 1852, doi:10.1097/01.ccm.0000277041.13090.0a (2007).
    1. de Mendonca A, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–921. doi: 10.1007/s001340051281.
    1. Uchino S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. Jama. 2005;294:813–818. doi: 10.1001/jama.294.7.813.
    1. Herrera-Gutierrez ME, Seller-Perez G, Maynar-Moliner J, Sanchez-Izquierdo-Riera JA. [Epidemiology of acute kidney failure in Spanish ICU. Multicenter prospective study FRAMI] Medicina intensiva. 2006;30:260–267. doi: 10.1016/S0210-5691(06)74522-3.
    1. Thakar CV, Christianson A, Freyberg R, Almenoff P, Render M. L. Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med. 2009;37:2552–2558. doi: 10.1097/CCM.0b013e3181a5906f.
    1. Hoste EA, De Corte W. Epidemiology of AKI in the ICU. Acta clinica Belgica. 2007;62(Suppl 2):314–317. doi: 10.1179/acb.2007.071.
    1. Hsu CN, et al. Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury: A Retrospective Cohort Study. Medicine. 2016;95:e3674. doi: 10.1097/MD.0000000000003674.
    1. Oluseyi A, Ayodeji A, Ayodeji F. Aetiologies and Short-term Outcomes of Acute Kidney Injury in a Tertiary Centre in Southwest Nigeria. Ethiopian journal of health sciences. 2016;26:37–44. doi: 10.4314/ejhs.v26i1.8.
    1. Wijewickrama ES, Ratnayake GM, Wikramaratne C, Sheriff R, Rajapakse S. Incidences and clinical outcomes of acute kidney injury in ICU: a prospective observational study in Sri Lanka. BMC research notes. 2014;7:1. doi: 10.1186/1756-0500-7-305.
    1. Naicker S, Aboud O, Gharbi MB. Epidemiology of acute kidney injury in Africa. Seminars in nephrology. 2008;28:348–353. doi: 10.1016/j.semnephrol.2008.04.003.
    1. Lombardi, R., Yu, L., Younes-Ibrahim, M., Schor, N. & Burdmann, E. A. inSeminars in nephrology. 320-329 (Elsevier).
    1. Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clinical journal of the American Society of Nephrology: CJASN. 2014;9:12–20. doi: 10.2215/CJN.02730313.
    1. De Corte W, et al. Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study. Critical care (London, England) 2016;20:256. doi: 10.1186/s13054-016-1409-z.
    1. Negi S, Koreeda D, Kobayashi S, Iwashita Y, Shigematu T. Renal replacement therapy for acute kidney injury. Renal Replacement Therapy. 2016;2:31. doi: 10.1186/s41100-016-0043-1.
    1. Koulouridis I, Price LL, Madias NE, Jaber BL. Hospital-acquired acute kidney injury and hospital readmission: a cohort study. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2015;65:275–282. doi: 10.1053/j.ajkd.2014.08.024.
    1. Organization, W. H. World Health Statistics 2014; 2014. Geneva Google Scholar (2015).
    1. Seller-Pérez G, et al. Acute kidney injury: Renal disease in the ICU. Medicina Intensiva (English Edition) 2016;40:374–382. doi: 10.1016/j.medine.2016.05.001.
    1. Simmons EM, et al. Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int. 2004;65:1357–1365. doi: 10.1111/j.1523-1755.2004.00512.x.
    1. Singbartl K, Joannidis M. Short-term Effects of Acute Kidney Injury. Critical care clinics. 2015;31:751–762. doi: 10.1016/j.ccc.2015.06.010.
    1. De Rosa S, Samoni S, Ronco C. Creatinine-based definitions: from baseline creatinine to serum creatinine adjustment in intensive care. Critical care (London, England) 2016;20:69. doi: 10.1186/s13054-016-1218-4.
    1. Broce JC, Price LL, Liangos O, Uhlig K, Jaber BL. Hospital-acquired acute kidney injury: an analysis of nadir-to-peak serum creatinine increments stratified by baseline estimated GFR. Clinical journal of the American Society of Nephrology: CJASN. 2011;6:1556–1565. doi: 10.2215/CJN.08470910.
    1. Bagshaw SM, et al. A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2009;24:2739–2744. doi: 10.1093/ndt/gfp159.
    1. Levey AS, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney international. 2011;80:17–28. doi: 10.1038/ki.2010.483.
    1. Dellinger RP, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive care medicine. 2013;39:165–228. doi: 10.1007/s00134-012-2769-8.
    1. Richards, J. B. & Wilcox, S. R. Diagnosis and management of shock in the emergency department. Emergency medicine practice16, 1–22; quiz 22–23 (2014).
    1. Initiative KDOQ. KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl. 2012;2:1–138. doi: 10.1038/kisup.2012.1.
    1. Chawla LS, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13:241–257. doi: 10.1038/nrneph.2017.2.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner