Outcomes of AKI audit in Kauvery

G. Balaji

Consultant Nephrologist, Kauvery Hospital, Trichy

Definition

AKI is defined as any of the following;

  1. Increase in SCr by ≥ 0.3 mg/dl (≥ 26.5 µmol/l) within 48 hr; or
  2. Increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
  3. Urine volume <0.5 ml/kg/hr for 6 hr
  4. Small fluctuations in serum creatinine have been included in the spectrum of AKI as they have an adverse effect on the overall outcome of the patient.

Diagnostic Criteria for AKI

Outcomes1

Long term systemic consequences of AKI

  1. Increased risk of cardio vascular events
  2. Increased risk of mortality
  3. Increased risk of stroke, hypertension
  4. Progression to CKD

Possible Outcomes of AKI

Outcomes2

AKI as a risk factor for CKD

  1. AKI- independent risk factor for CKD
  2. Hastens the progression in preexisting CKD
  3. Increased risk for ESRD
  4. Increases the risk for early mortality

Age Distribution

Age Range

Frequency

Percent

<18 31 7.9
19-30 49 12.4
31-40 30 7.6
41-50 59 15.0
51-60 76 19.3
>60 149 37.8
Total 394 100.0

Adm Creat

Frequency

Percentage

Less than 1 – Normal 209 53.0
More than 1 – Abnormal 185 47.0
Total 394 100.0

Overall Outcome

Status

Frequency

Percentage

Discharged 231 58.6
AMA 62 15.7
Death 86 21.8
Referred to OH 15 3.8
Total 394 100.0

ETIOLOGY

Frequency

Percentage

Acute Liver Failure 8 2.0
Acute Pancreatitis 6 1.5
AKI- glomerular 5 1.3
CAD 4 1.0
Cancer Related 3 0.8
CKD 36 9.1
DCLD/ALF 25 6.3
Dengue Fever 21 5.3
DKA 16 4.1
Drug Induced 2 0.5
Hanging 9 2.3
HIE 4 1.0

Etiology

Frequency

Percentage

Obstetric 11 2.8
Poisoning 23 5.8
Ratol 2 0.5
Trauma/RTA 14 3.6
Seizure 9 2.3
Sepsis/MODS/Shock 109 27.7
Snake Bite 3 0.8
Transfusion Related 1 0.3
Pneumonia/ Respiratory 74 18.8
Tropical 2 0.5
Ulcer Bleed 4 1.0
Vascular 3 0.8
Total 394 100.0

Age Distribution

Age Range

Frequency

Percentage

<18 31 7.9
19-30 49 12.4
31-40 30 7.6
41-50 59 15.0
51-60 76 19.3
More than 60 149 37.8
Total 394 100.0

Age Based Outcome

Age Range

Status

Total

%

DISCHARGED

%

AMA

%

Death

%

Refer to OH

%

<18 24 10.4 1 1.6 6 7.0 0 0.0 31 7.9
19-30 37 16.0 5 8.1 7 8.1 0 0 49 12.4
31-40 18 7.8 7 11.3 4 4.7 1 6.7 30 7.6
41-50 31 13.4 13 21.0 13 15.1 2 13.3 59 15.0
51-60 38 16.5 11 17.7 20 23.3 7 46.7 76 19.3
More than 60 83 35.9 25 40.3 36 41.9 5 33.3 149 37.8
Total 231 62 86 15 394

Diagnosis Status

Diagnosis

Status

Total

%

Alive

%

AMA

%

Death

%

Refe to OH

%

Acute Liver Failure 4 1.7 1 1.6 3 3 0 0.0 8 2.0
Acute Pancreatitis 4 1.7 1 1.6 1 1 0 0.0 6 1.5
AKI 3 1.3 0 0.0 2 2 0 0.0 5 1.3
CAD 2 0.9 2 3.2 0 0 0 0.0 4 1.0
Cancer Related 1 0.4 0 0.0 2 2 0 0.0 3 0.8
CKD 16 6.9 5 8.1 12 14 3 20.0 36 9.1
DCLD/CLD 7 3.0 8 12.9 9 10 1 6.7 25 6.3
Dengue Fever 16 6.9 2 3.2 2 2 1 6.7 21 5.3
DKA 11 4.8 2 3.2 3 3 0 0.0 16 4.1
Drug Induced 1 0.4 0 0.0 0 0 1 6.7 2 0.5
Hanging 8 3.5 0 0.0 0 0 1 6.7 9 2.3
Hypoxic 1 0.4 2 3.2 1 1 0 0.0 4 1.0
Obstetric 11 4.8 0 0.0 0 0 0 0.0 11 2.8
Poisoning 17 7.4 4 6.5 0 0 2 13.3 23 5.8
Ratol 2 0.9 0 0.0 0 0 0 0.0 2 0.5
Trauma/ RTA 8 3.5 1 1.6 5 6 0 0.0 14 3.6
Seizure 8 3.5 1 1.6 0 0 0 0.0 9 2.3
Sepsis/MODS/Shock 56 24.2 17 27.4 35 41 1 6.7 109 27.7
Snake Bite 1 0.4 1 1.6 1 1 0 0.0 3 0.8
Transfusion Related 0 0.0 1 1.6 0 0 0 0.0 1 0.3
Pneumonia/ respiratory 46 19.9 14 22.6 9 10 5 33.3 74 18.8
Tropical 2 0.9 0 0.0 0 0 0 0.0 2 0.5
Ulcer Bleed 4 1.7 0 0.0 0 0 0 0.0 4 1.0
Vascular 2 0.9 0 0.0 1 1 0 0.0 3 0.8
Over all 231 58.62 62 15.7 86 21.8 15 4 394 100

Overall Outcome

Status

Frequency

Percent

Alive 231 58.6
AMA 62 15.7
Death 86 21.8
Referred to OH 15 3.8
Total 394 100.0

Age Range

Frequency

Percent

<18 31 7.9
19-30 49 12.4
31-40 30 7.6
41-50 59 15.0
51-60 76 19.3
More than 60 149 37.8
Total 394 100.0

Sex Based Outcomes

Sex

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Male 138 59.7 41 66.1 60 69.8 10 66.7 249 63.2

χ2= 0.378 NS

Female 93 40.3 21 33.9 26 30.2 5 33.3 145 36.8
Total 231 62 86 15 394

Diabetes Mellitus

T2DM

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Yes 91 39.4 34 54.8 40 46.5 9 60.0 174 44.2

χ2= 0.082 NS

No 140 60.6 28 45.2 46 53.5 6 40.0 220 55.8
Over all 231 62 86 15 394

Hypertension

S HTN

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Yes 87 37.7 26 41.9 30 34.9 5 33.3 148 37.6

χ2= 0.829 NS

No 144 62.3 36 58.1 56 65.1 10 66.7 246 62.4
Over all 231 62 86 15 394

 

COPD

COPD vs Group

COPD

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Yes 21 9.1 9 14.5 3 3.5 3 20.0 36 9.1

χ2= 0.055 SIG

No 210 90.9 53 85.5 83 96.5 12 80.0 358 90.9
Over all 231 62 86 15 394

DCLD

DCLD

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Yes 6 2.6 7 11.3 12 14.0 2 13.3 27 6.9

χ2= 0.001 SIG

No 225 97.4 55 88.7 74 86.0 13 86.7 367 93.1
Over all 231 62 86 15 394

CKD

CKD

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Yes 20 8.7 8 12.9 14 16.3 2 13.3 44 11.2

χ2= 0.262 NS

No 211 91.3 54 87.1 72 83.7 13 86.7 350 88.8
Over all 231 62 86 15 394

CAD

CAD

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Yes 38 16.5 18 29.0 12 14.0 5 33.3 73 18.5

χ2= 0.036 SIG

No 193 83.5 44 71.0 74 86.0 10 66.7 321 81.5
Over All 231 62 86 15 394

CVA

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

10 4.3 2 3.2 2 2.3 2 13.3 16 4.1

χ2= 0.248 NS

221 95.7 60 96.8 84 97.7 13 86.7 378 95.9
231 62 86 15 394

Length of Hospital Stay

LOHS

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

0-2 Days 8 3.5 17 27.4 20 23.3 6 40.0 51 12.9

χ2= 0.000 SIG

3-7 Days 88 38.1 29 46.8 26 30.2 5 33.3 148 37.6
8-14 Days 85 36.8 8 12.9 28 32.6 4 26.7 125 31.7
14-21 Days 22 9.5 3 4.8 8 9.3 0 0.0 33 8.4
More than 22 days 28 12.1 5 8.1 4 4.7 0 0.0 37 9.4
Over all 231 62 86 15 394

Admission Creatinine

Adm Creat

Status

Total

%

P – Value

Alive

%

AMA

%

Death

%

Refer to OH

%

Less than 1 147 63.6 29 46.8 29 33.7 4 26.7 209 53.0

χ2= 0.000 SIG

More than 1 84 36.4 33 53.2 57 66.3 11 73.3 185 47.0
Over All 231 62 86 15 394

Discussion

  1. Acute kidney injury (AKI) is associated with increased morbidity and mortality in patients. The risk increased if associated with other co morbidities. AKI is also an independent risk factor for chronic kidney disease.
  2. At Kauvery hospital, Cantonment we analysed the clinical outcome of AKI data for patients admitted between January 2023 to October 23.
  3. A 394 patients were included in the study.249 were male patients and 145 were female patients. Most of our patients were aged 50 and above and many of them had co morbidities like DM, HT, CAD, CLD, CKD. The most common cause of AKI in our study was sepsis (24.2%) followed by respiratory tract infections (19.9%). The next common etiologies were Poisoning (7.4%) and Dengue (6.9%).7% of patients with AKI had a pre-existing CKD. Presence of pre-existing CLD, CAD, and COPD were significant risk factors for developing AKI.
  4. The overall mortality in our study was 21.8%. The 58.3% of patients were discharged alive with improving renal parameters .outcomes and the remaining 19.5% people could not be assessed as they were discharged due to various reasons.

Conclusion

AKI is an important risk factor for increased morbidity and mortality in ICU setup in any tertiary care hospital. Presence of AKI in association with co morbidities increase the patient’s mortality. Infections are the leading cause of AKI in our hospital. Identifying AKI early and timely appropriate treatment will reduce the burden on both patient and hospital

Outcomes3

Dr. G. Balaji

Consultant Nephrologist