Elavazhagan, B (2013) A Study on Acute Kidney Injury in Intensive Care Setting. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Acute kidney injury is not a single disease but a terminology for a group of conditions that have similar diagnostic features, importantly, an elevation in the blood urea nitrogen (BUN) level and / or an elevation in the plasma or serum creatinine (S.Cr) concentration, often associated with a decrease in urine volume. AKI can vary in severity from asymptomatic and transient changes in laboratory measures of glomerular filtration rate (GFR), to exaggerated and rapidly fatal derangements in effective circulating blood volume, electrolyte and acid-base composition of the plasma. AKI is the cause for 5–7% of acute care hospital admissions and 30% of intensive care admissions. The epidemiology of AKI varies enormously between developed and developing regions, because of differences in demographics, social and cultural factors. But recent change in cultural habits, life style changes and social values in developing regions produce the near similar picture as developed countries. The incidence of AKI has increased by more than fourfold in the United States from 1988 and is calculated to have a yearly incidence of 500 per 100,000 persons, more than the yearly incidence of cerebrovascular accidents. AKI causes a markedly increased risk of death in hospitalized persons, especially in those admitted to the ICU where in patient death rates may be more than 50%. The term acute renal failure was changed to "acute kidney injury." The term failure denotes only portion of the spectrum of damage to the kidney that occurs clinically. Also the term renal is not well understood in the general population and this makes understanding with patients and their caretakers more difficult; so the term renal failure has been changed to acute kidney injury. Western literature has lot of data regarding the occurrence and nature of acute kidney injury both in the community and inpatient setting. Sadly we are lagging behind in this regard as there are not many records or reports on this topic .This prompted me to take up this study which would throw light on the present scenario of acute kidney injury in intensive care unit. I sincerely believe in the relevance of this topic in our set up and hence chose this topic as my dissertation. AIMS AND OBJECTIVES: 1. To identify the incidence of acute kidney injury, their etiological factors, associated comorbid factors, interventions, and outcome in intensive care setting. 2. To address the factors which predict the mortality in acute kidney injury. MATERIALS AND METHODS: Study Design: Prospective observational study. Study Place: Intensive medical care ward (IMCW) in Stanley Medical College and Hospital, Chennai. Study Duration: May 2012 to October 2012 (6 months). Study Population: Those who were admitted in IMCU in that period, and also having acute kidney injury. Inclusion Criteria: According to RIFLE criteria 1. Patients who developed acute kidney injury during the hospital stay. 2. Patients who developed acute kidney injury in the community. 3. Patients who developed newer insult to a pre existing disease. Exclusion Criteria: 1. CKD patients who are in maintenance hemodialysis. 2. Patients who got admitted and expired within 24 hours. 3. Those who are not willing for the study. After getting approval from institutional ethical committee, the study was started in IMCW. Patients were given the consent form, and explanation was given. Those who were willing to participate were included in the study. STATISTICAL ANALYSIS: Statistical analysis was performed using IBM SPSS version 20. All categorical data were expressed as percentage of the whole. The continuous variables were expressed as Mean ± Standard Deviation. Univariate analysis was performed using Chi Square test for categorical data and Mann Whitney U test was used for the continuous variables. The significance level was fixed at p<0.05. Adjusted Odds ratio with 95% Confidence interval was calculated as an estimate of the risk in those variables with statistically significant differences between the groups. Those variables which had p values less than 0.15 in the univariate model entered the multivariate logistic regression in backward conditional method. The odds ratio (Exp[B]) and level of significance (p) were obtained in the regression analysis. Variables with p<0.05 were taken as significant. RESULTS: The study was conducted in our IMCW for 6 months. The study results were as follows: During the six month period total number of IMCU admissions were 700. The total no patients who developed AKI were 83. The incidence of acute kidney injury was 118 per 1000 admissions. About 11.9% of the admissions had AKI in our IMCW. Among the 83 cases, 43 cases were expired and 40 were discharged from ICU. The mortality rate was 51.8%. SUMMARY: Acute kidney injury, a common problem in ICU, has a strong impact in the mortality and morbidity. Although there are rampant studies available in the west, there are less than a handful of study in south India. We had few similarities and dissimilarities in comparison to the western literature. Results comparable to study done elsewhere: • Incidence of AKI is11.7%. • Mortality rate is 51.8%. • Most common causes of AKI are sepsis, shock, and hepatorenal syndrome. • Predictors of mortality are persistent oliguria requiring renal replacement therapy, hypotension, ventilator support. • Incidence of AKI is more than acute on chronic kidney disease. Results dissimilar to study done elsewhere: • Severity of AKI as per RIFLE did not correlate with mortality. • Patients in RIFLE(R) were less in number. • Age had no say in the mortality. • Coexistent diabetes and hypertension did not influence the mortality. There is one parameter, which is not taken into consideration in other studies (to the best of my knowledge), which is a independent predictor of mortality, is spot urine sodium (> 40). Further studies on large scale are required to prove its significance. In short, infections and hypotension are the most common cause of mortality. Diligent care should be taken to find the etiology and to maintain fluid homeostasis. Patients who are oliguric and/or on ventilator should be managed with special precautions, as they are significant predictors of mortality.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Acute Kidney Injury ; Intensive Care Setting. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Mar 2018 07:08 |
| Last Modified: | 28 Mar 2018 01:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6577 |
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