OUTCOME AND CLINICO-ETIOLOGICAL PROFILE OF PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS

Background: Despite advances in critical care nephrology, the outcome of acute kidney injury (AKI) among hospitalized patient is poor in developing countries. Data on the outcome of hemodialysis requiring AKI is limited from India. We studied the epidemiology, clinical prole and outcome of haemodialysis requiring AKI in a tertiary care centre from South India. Methods: This is a prospective observational study among patients aged above 12 years admitted with dialysis requiring AKI . Diagnosis and staging of AKI was done based on KDIGO AKI guidelines. Patients were dialyzed if they had any of the following indications.-1.Refractory metabolic acidosis 2.Refractory hyperkalemia 3.Uremic encephalopathy 4.Uremic Pericarditis 5.Refractory pulmonary edema 6.Anuric renal failure irrespective of duration of AKI .Our primary objective was to study the outcome at the end of 3 months of follow up and the risk factors association with poor outcome. Outcome was assessed as mortality percentage, recovery (dened as normalization of serum creatinine/ improvement in eGFR to more than 60 ml/min/1.73 m2) percentage and CKD ( dened as eGFR <60 ml/min/1.73 m2) percentage. The Results: mean age of 100 patients included in our study was 45 ± 20 years, and there was a male preponderance (n =63, 63 %). The most common co morbidities were diabetes mellitus (n= 32, 32 %) and hypertension (n=28, 28 %).The stage of AKI at the time of admission was, AKI stage 1(n= 2,2%),AKI stage 2 (n=18,18%) and AKI stage (n=80,80%) .The mean serum creatinine was 5.14 ± 2.2 mg/dl on admission. The mean number of dialysis sessions given was ( 9.75±5.8) .The most common aetiologies for dialysis requiring AKI were acute diarrheal disease (n= 43,43%) ,urinary tract system (n=14,14%) and burns (n=9%). At the end of 3 months of follow up, 63% (n=63) of patients had recovery,24%(n=24) expired and 13%)(n=13) had CKD. Male sex ( p=0.018), elderly age 61yrs-70yrs( p=0.014) , stage 2 (18%) (p=0.043)stage 3 AKI (80%) at the time of admission(p=0.013), low serum albumin ( <3.5 gm/dl) at the time of admission( p=0.00001), were the risk factors signicantly associated with mortality. Low serum albumin ( < 3.5 gm/dl ( p=0.00014), and stage 3 AKI at the time of admission ( p=0.04), were the risk factors signicantly high among those who progressed to CKD. Our study highlights that Conclusion: dialysis requiring AKI is associated with high mortality and high risk of CKD/ESRD, reinforcing the importance of long term follow up of these patients. Also since majority of the patients in our study had preventable causes of AKI, it is of prime importance, to focus on the prevention of AKI to reduce the CKD burden.