Acute kidney injury: Prevalence and outcomes in southern Indian population

Introduction: Acute Kidney Injury (AKI) is characterised by a rapid reduction in the kidney function and gets effected to varying degrees based on the aetiology. An AKI increases the chances of Chronic Kidney Disease (CKD) if not treated properly or assessed timely. Aim: To identify the common aetiologies and to assess the prognosis and outcomes of AKI in a tertiary care centre in southern India. Materials and Methods: A retrospective observational study was conducted, in a tertiary care teaching hospital over a period of six months (August 2015 to February 2016), upon receiving approval from Institutional Ethics Committee (KH IEC 392/2015). Data of patients aged ≥18 years admitted during January-December 2012 was collected from the medical records using the ICD10 code for AKI, unspecified (N17.9). Patients with renal transplantation and chronic dialysis were excluded. Age, gender, aetiology, management, and association between treatment and outcome were analysed using descriptive statistics, univariate and multivariate logistic regression and chi square test. Results: Among 528 patients, with AKI, male predominance of 72.7% (n=384) and median {Interquartile Range (IQR)} age of 56 (20) years was observed. Prevalence of AKI was found to be 8.36/1,000 people. Community Acquired-AKI (CA-AKI) and Hospital Acquired-AKI (HA-AKI) accounted for 35% (n=185) and 65% (n=343) respectively. CKD 23% (n=79) and sepsis 22.4% (n=77) were the major aetiologies among CA-AKI whereas sepsis 49.2% (n=91) and CKD 11.9% (n=22) were the majorities among the HA-AKI. Chi square test for association between treatment and outcomes (recovery) showed a statistically significant relationship with dextrose normal saline (χ²=10.96, p<0.05), sodium bicarbonate (χ²=7.63, p<0.05), dopamine (χ²=112.14, p<0.05), calcium gluconate (χ²=17.20, p<0.05) and haemodialysis (χ²=12.13, p<0.05). Complete recovery in 64% (n=341) whereas 16% (n=82) of patients died. Conclusion: Sepsis and CKD were seen to be the leading aetiologies. Male gender with AKI is more likely to develop CKD. AKI with Diabetes Mellitus (DM), sepsis or Urinary Tract Infection (UTI) might worsen the prognosis. Fluid replenishment shows to improve the prognosis.