Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

T B Singh, S S Rathore, T A Choudhury, V K Shukla, D K Singh, J Prakash, T B Singh, S S Rathore, T A Choudhury, V K Shukla, D K Singh, J Prakash

Abstract

Acute kidney injury (AKI) is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI) in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years) of either gender who developed AKI based on RIFLE criteria (using serum creatinine), 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively (P < 0.0001). There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward (P = 0.001). RIFLE-R was the most common AKI in medical (39.2%) and ICU (50%) wards but in the surgical ward, it was RIFLE-F that was most common (52.6%). Acute tubular necrosis was more common in ICU (P = 0.043). Most common etiology of HAAKI in medical unit was drug induced (39.2%), whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively). Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively (P = 0.003). Length of hospital stay in surgical, ICU and medical units were different (P = 0.007). This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

Keywords: Epidemiology; RIFLE criteria; hospital acquired acute kidney injury; mortality.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Kellum JA, Levin N, Bouman C, Lameire N. Developing a consensus classification system for acute renal failure. Curr Opin Crit Care. 2002;8:509–14.
    1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P Acute Dialysis Quality Initiative workgroup. 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:R204–12. [Last accessed 2011 Oct 23]
    1. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. [Last accessed 2011 Oct 23];Crit Care. 2007 11:R31. Available from: .
    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA. 2005;294:813–8.
    1. Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: A national survey. Clin J Am Soc Nephrol. 2006;1:43–51.
    1. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units–causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996;24:192–8.
    1. Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: A prospective study. Am J Med. 1983;74:243–8.
    1. Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: An update and primer for the intensivist. Crit Care Med. 2010;38:261–75.
    1. Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, et al. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): Targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol. 2007;2:418–25.
    1. Liaño F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl. 1998;66:S16–24.
    1. Avasthi G, Sandhu JS, Mohindra K. Acute renal failure in medical and surgical intensive care units: A one year prospective study. Ren Fail. 2003;25:105–13.
    1. Jha V, Malhotra HS, Sakhuja V, Chugh KS. Spectrum of hospital-acquired acute renal failure in the developing countries: Chandigarh study. Q J Med. 1992;83:497–505.
    1. Prakash J, Singh SP, Kumar OM, Malhotra V, Tripathi K, Srivastava PK. Hospital acquired acute renal failure. Indian J Nephrol. 1996;6:9–13.
    1. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55.
    1. Shusterman N, Strom BL, Murray TG, Morrison G, West SL, Maislin G. Risk factors and outcome of hospital-acquired acute renal failure. Clinical epidemiologic study. Am J Med. 1987;83:65–71.
    1. Kohali HS, Bhaskaran MC, Muthukumar T, Thennarasu K, Sud K, Jha V, et al. Treatment related acute renal failure in elderly: A hospital based prospective study. Nephrol Dial Transplant. 2000;15:212–7.
    1. Yarlaggada S, Perazella MA. Acute renal failure in the hospital: Diagnosis and management. Hosp Physician. 2006;3:51–8.
    1. Davidman M, Olson P, Kohen J, Leither T, Kjellstrand C. Iatrogenic renal disease. Arch Intern Med. 1991;151:1809–12.
    1. Abraham G, Gupta RK, Senthilselvan A, van der Meulen J, Johny KV. Cause and prognosis of acute renal failure in Kuwait: A 2-year prospective study. J Trop Med Hyg. 1989;92:325–9.
    1. de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–21.
    1. Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck CH, Jr, Fischer JE. Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg. 1976;71:323–33.
    1. El-Lozi M, Akash N, Gneimat M, Smadi I, Nimri M, Hadidi M. Hospital acquired acute renal failure. Saudi J Kidney Dis Transpl. 1996;7:378–82.
    1. Biradar V, Urmila A, Renuka S, Pais P. Clinical spectrum of hospital acquired renal failure: A study from tertiary care hospital. Indian J Nephrol. 2004;14:93–6.
    1. Prakash J, Murthy AS, Vohra R, Rajak M, Mathur SK. Acute renal failure in the intensive care unit. J Assoc Physicians India. 2006;54:784–8.
    1. Mahajan S, Tiwari S, Bharani R, Bhowmik D, Ravi S, Agarwal SK, et al. Spectrum of acute renal failure and factors predicting its outcome in an intensive care unit in India. Ren Fail. 2006;28:119–24.
    1. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–6.
    1. Shema L, Ore L, Geron R, Kristal B. Hospital-acquired acute kidney injury in Israel. Isr Med Assoc J. 2009;11:269–74.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅