Epidemiology and Outcomes of Dialysis Requiring Acute Kidney Injury: A Single-Center Study.

Abstract

OBJECTIVES\nAcute Kidney Injury (AKI) is a common diagnosis in hospitalized patients. Dialysis requiring AKI (AKI-D) is associated with adverse outcomes. This study aims to know the clinical profile and short-term outcomes at three months, in patients with AKI-D, at our center.\n\n\nMETHODS\nA prospective observational study was done of all the patients admitted with AKI-D for two years, from July 2018 to June 2020. We recorded clinical parameters at baseline and post-discharge follow-up at three months.\n\n\nRESULTS\nOne hundred twenty-eight patients had AKI-D over two years. 116 (90.6%) patients had community-acquired AKI (CAAKI), and 12 (9.4%) patients had hospital-acquired AKI (HAAKI). The underlying causes of AKI-D were: toxins in 48 (37.5%), sepsis 31(24.2%), acute kidney disease (AKD)15 (11.7%), acute gastroenteritis (AGE) 9 (7%), and cardiogenic shock in 7 (5.5%) patients. The mean values of intact parathyroid hormone (available in 32% of patients) were 268 pg/ml. Intermittent hemodialysis (IHD) was the commonest mode of dialysis (85.2%). A kidney biopsy was done in 23 (18%) patients. The most common diagnosis on kidney biopsy was glomerulonephritis (GN) in 12 patients (Crescentic GN-9 and IgA nephropathy-3), followed by acute tubule-interstitial nephritis in 6 patients. In-hospital mortality was 29.7%. Overall, 39% regained serum creatinine in the normal range at three months, 36.7% died, 14.1% reached chronic kidney disease (CKD), 7.8% lost to follow-up, and 2.3% had reached end-stage renal disease.\n\n\nCONCLUSION\nThe majority of AKI-D at our centre was CAAKI. A significant chunk of AKI-D (68.7%) was caused by preventable causes like toxins, sepsis, and AGE. Dysregulation of mineral metabolism was conspicuous. In chemical toxin versus biological toxins and undifferentiated sepsis versus the identifiable cause of sepsis, formers had significantly more in-hospital mortality than the latter ones. AKI-D is associated with high in-hospital mortality, total mortality, and risk of progression to CKD at three months. This article is protected by copyright. All rights reserved.