Spectrum of Acute Kidney Injury and its Outcome in Intensive Care Unit in Tertiary Care Center in India

OBJECTIVE: To determine the incidence and outcome of acute kidney injury (AKI) in critically ill patients and to evaluate RIFLE criteria in critically ill patients. Prospective observational study.

MATERIAL and METHODS: 130 patients diagnosed with AKI in the intensive care unit were studied prospectively. All patients were evaluated for the etiology of AKI. Serum creatinine levels were measured at the time of discharge from the hospital as well as during the follow-up period (2 months).

RESULTS: The incidence of AKI was 17.81%. The mean age of the study group was 57.9 years. Sepsis was the predominant cause of AKI (35%). The distribution of the RIFLE group was Risk-6.9 %, Injury – 41.5 % and Failure – 46.6 %. Increasing severity of acute kidney injury is associated with the need for longer duration of inotropes, number of inotropes and ventilator care. The overall mortality was 24.62 %, the highest in loss group (57.1%) followed by failure (31.7%), injury (14.8 %) and risk group (11.1%). Renal replacement therapy (RRT) was required in 58 patients (44.6 %). The mortality in the RRT group was 75%. Survival benefit was more among patients with early initiation of RRT (p=<0.001). At the end of 60 days of follow-up, out of 130 patients with AKI, 98 patients had recovery of their renal function. Complete recovery was found in 85% of patients and the rest 15% had only partial recovery of their renal function.

CONCLUSION: This study shows that there is a stepwise increase in relative risk of death going from Risk to Failure of RIFLE stage and early initiation of RRT may be beneficial in critically ill AKI patients.