A STUDY OF ACUTE KIDNEY INJURY IN CRITICALLY ILL MEDICAL AND SURGICAL PATIENTS IN BUNDELKHAND REGION

Abstract

Introduction: Acute kidney injury (AKI), previously known as acute renal failure, is characterized by the sudden impairment of kidney function resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys. The acute kidney injury (AKI) incidence in ICU patients varies widely from 3% to 30%, with mortality ranging from 36% to 90%, depending on the type of ICU, study population, the period during which the study is conducted, and the criteria used to define AKI.The present study was undertaken to study the clinical profile of AKI prospectively in various medical and surgical intensive care units in our hospital—a tertiary care center in north India.

Aims and objectives:To assess the incidence of AKI among critically ill patients,determine the prevalence of AKI in Intensive Care Unit patients,characterize differences in etiology and severity of AKI and to determine the impact of AKI on patients outcomes alongwith a comparative study to know the epidemiological and clinical profiles of AKI in surgical & medical ICU units.

Materials and methods: The study included a total of 170 patients and was carried out in the Department of General Medicine, M.L.B. Medical College, Jhansi (U.P.) from March. 2018 to Oct. 2019.Patients with suspected Acute Kidney Injury (AKI) in Medical & Surgical ICU units,staying for a minimum of 48 hrs in ICU and with age more than 12 yrs were included in the study while those who remained in the ICU for less than 6 hrs,having preexisting end-stage kidney disease on chronic dialysis,with prior renal transplant and who already had developed CKD were excluded.

Results: A total of 45.29% patients of the total critically ill patients developed AKI in our study from AKIN criteria out of which most of the patients were from medical ICU where AKIN grade III was the most common grade of AKI.Age >60, male gender were prevalent in the majority of AKI patients and represented 31.17% and 71.43% population respectively. Male to female ratio was around 2.5:1.Sepsis was the most common cause of AKI in the critically ill patients of our study and it was found in 35.06% of the patients which was followed by Acute gastroenteritis and various types of Poisoning that constituted 18.18% of patients.Of the 77 patients developing AKI, 40(51.94%) were having qSOFA score between 0 to 1 while rest 37(48.06%) were having qSOFA score of 2-3.Crude mortality rate among patients with AKI in our study group was 36.36%%.Almost half of the patients having AKI (49.35%) were improved.Majority of the patients did not require RRT and were treated conservatively. 72.72% of the total patients with AKI didn’t require any RRT while it was given in 27.28% patients.the patients who received RRT were mostly from medical ICUs Among those who were put on RRT,57.14% expired while 23.81% patients improved.Anuria was the commonest factor warranting need of RRT and it was present in 90.48% of those patients while acidosis was present in 76.19% patients.