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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 130-133

Clinical profile of acute kidney injury in a tertiary care center in the Tropical Region


1 Department of Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, New Delhi, India
2 Department of Nephrology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, New Delhi, India
3 Department of Medicine, Northern Railway Central Hospital, New Delhi, India

Date of Web Publication27-May-2019

Correspondence Address:
Dr. Amit S Pasari
Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jina.jina_15_18

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  Abstract 


Objective: The objectives of the study were to study etiology, manifestations, and outcome of acute kidney disease in the tropical region in a tertiary care center. Materials and Methods: In the present prospective study, patients with acute kidney disease admitted to JNMC, Wardha, India, between January 2017 and December 2017 were studied with a detailed history, general physical examination, and systemic examination. Data were collected and analyzed. Statistical analysis was performed using descriptive and inferential statistics using the Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 22.0 version and Graph Pad Prism 6.0 version. Results: This study showed male-to-female ratio of 1.8:1. Maximum incidence was seen in patients aged >60 years. As per the Kuppuswamy's scale, most of the patients belonged to lower-middle and upper lower class. The study showed various etiological factors associated with acute kidney injuries (AKIs) such as renal causes (most common), heart failure, respiratory failure, cirrhosis, malaria, snake bite, acute gastroenteritis, poisoning, drug nephrotoxicity, and sepsis. Common symptoms were oliguria followed by pedal edema and dyspnea. The most common comorbid illness was hypertension followed by diabetes mellitus which may have made them prone to AKI. About 81.42% of patients survived and 18.58% expired. Of 70, 56 patients were managed conservatively, whereas 14 underwent hemodialysis. Mean duration of hospitalization was 11.01 ± 8.60 days. Conclusion: Intrinsic renal causes followed by heart failure were the common causes of AKI as against infective causes a few years earlier. This shows the changing trend of AKI causes in a developing nation. Average duration of hospitalization was 11 days in the study.

Keywords: Acute kidney injury, clinical profile, outcome of acute kidney injury, tropical region


How to cite this article:
Patel UR, Pasari AS, Balwani MR, Bhawane A, Tolani PR, Acharya S. Clinical profile of acute kidney injury in a tertiary care center in the Tropical Region. J Integr Nephrol Androl 2018;5:130-3

How to cite this URL:
Patel UR, Pasari AS, Balwani MR, Bhawane A, Tolani PR, Acharya S. Clinical profile of acute kidney injury in a tertiary care center in the Tropical Region. J Integr Nephrol Androl [serial online] 2018 [cited 2019 Aug 20];5:130-3. Available from: http://www.journal-ina.com/text.asp?2018/5/4/130/259161




  Introduction Top


Acute kidney injury (AKI) is one of the leading causes of intensive care unit admissions and a common contributor to in-hospital mortality rates. The global burden of AKI is estimated at 13.3 million cases per year, with 85% from low- and middle-income countries.[1],[2] AKI is associated with increased length of hospital stay and in turn leads to higher treatment cost.[3] The duration and severity of AKI is a risk factor for the development of complications such as a 10-fold increase in the risk of chronic kidney disease and a 3-fold risk of end-stage renal disease.[4],[5],[6] Limited data on the incidence are available worldwide and the data vary widely across studies depending on the setting and the populations investigated. Data on the epidemiology of AKI in central India, in particular, are limited. The incidence in this setting is difficult to know due to the lack of national registries. Because AKI is associated with high mortality, identifying patients early and intervening to avoid renal replacement therapy is necessary. The present study was undertaken to investigate the clinical profile of AKI presenting to a tertiary care teaching hospital.


  Materials and Methods Top


This was a prospective study carried out over a period of 1 year (January 2017–December 2017) at a tertiary care hospital Jawaharlal Nehru Medical College, Sawangi, Maharashtra, India.

AKI was defined according to the modified KDIGO 2012 criteria as an increase in serum creatinine of 0.3 mg/dL or greater or an increase of 50% or more from the reference value obtained at admission or the known baseline value.[7] Patients with chronic renal failure, acute on chronic renal failure and those not willing to participate were excluded from this study. Evaluation included a detailed history, physical examination, and laboratory investigations. Kuppuswamy's scale was used to assess the socioeconomic status of participants.[8] Patients were followed up until discharge or death. Each patient was looked for the complications of AKI-like fluid overload, hypertension, electrolyte abnormalities, metabolic acidosis, uremic complications, bleeding, neurological abnormalities, and infections. Hemodialysis was instituted as and when required. The study was approved by the Institutional Ethics Committee. Data were collected and analyzed. Statistical analysis was performed using descriptive and inferential statistics using the Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 22.0 version (IBM Corp., Armonk, NY).


  Results Top


Demographics

The study included a total of 70 patients diagnosed with AKI. [Table 1] shows the demographic characteristics of the patients included in the study. Among the study population, 13 participants were aged 18–20 years, 24 were aged 40–60 years, and 33 were aged 60 and above. Among the study population, 45 (64.2%) were male and the remaining 25 (35.8%) were female. Maximum incidence was seen in patients aged >60 years [Table 1]. The mean age was 55.64 ± 17.14 years (20–90 years).
Table 1: Distribution of patients according to demographic characteristics

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Socioeconomic factors

AKI was common in the lower middle class and upper lower class as per the modified Kuppuswamy's scale [Table 2].
Table 2: Distribution of patients according to socioeconomic status

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Clinical presentation

The most common presenting complaints in patients with AKI in descending order were fever, edema, breathlessness, joint pain, and vomiting [Table 3].
Table 3: Distribution of patients according to their clinical presentation of acute kidney injury

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Comorbid illness

Around 35% of participants had a history of hypertension and 14% of patients had underlying diabetes mellitus at the time of presentation [Table 4].
Table 4: Distribution of patients according to comorbid illness

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Etiology of acute kidney injury

Among the study population, renal disease (including obstructive uropathy, urinary tract infections, and intrinsic renal disease) was the most common cause (around 25%) of AKI followed by cardiac and respiratory cause. Acute gastroenteritis and liver disease accounted for around 11% of cases of AKI [Table 5].
Table 5: Distribution of patients according to their medical causes of acute kidney injury

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Hemodialysis and duration of hospitalization

Of 70 patients, 56 were managed conservatively whereas 14 required hemodialysis support. Most of the patients (approximately 81%) required hospitalization for around 2 weeks during which the majority of patients recovered. About 7% of patients required hospitalization for >3 weeks [Table 6]. Mean duration of hospitalization was 11.01 ± 8.60 days.
Table 6: Distribution of patients according to duration of hospitalization

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Outcome of acute kidney injury

Thirteen out of 70 patients died during hospitalization (around 18.58%). Rest either recovered completely or were discharged in a stable condition with recovering AKI [Table 7].
Table 7: Distribution of patients according to recovery/mortality

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  Discussion Top


In this study, AKI was the most common in patients >60 years of age. The mean age was 55.64 ± 17.14 years. In one study, more than four-fifths of studied patients were aged >40 years.[9] In this study, AKI was commonly seen in lower middle class and upper lower class as per the modified Kuppuswamy scale. It is probably due to low socioeconomic conditions, hot climate (resulting in peripheral vasodilatation), which in conjunction with excessive sweating predisposes to hypovolemic insults. The most common presenting complaints in our study were fever and edema followed by breathlessness. Around one-third of patients had hypertension as comorbid illness and 14% of patients had underlying diabetes mellitus at the time of presentation. Elderly patients usually develop hypertension and diabetes mellitus as was seen in our patients and they had a high incidence of AKI in the study. Among the study population, renal disease accounted for maximum cases presenting as obstructive uropathy, urinary tract infections, and intrinsic renal disease (around 25%). It was followed by cardiac and respiratory causes. Acute gastroenteritis and liver disease accounted for around 11% of cases of AKI. Osman et al. found volume depletion as a common cause of AKI in his study.[10] Pneumonia was the leading cause in the study of Ghimire et al. in Nepal followed by gastroenteritis and urinary tract infection.[11] In the present study, 10% of AKI were due to poisoning and sepsis. Poisoning cases were most commonly because of organophosphorus (OP) compounds. Lee et al. have demonstrated six-fold increased risk of AKI in patients with OP poisoning.[12] Sepsis was seen in one-third of total patients presenting as AKI.[13] The contribution by snakebite cases was around 4% in our study.

The pooled rate of dialysis requirement for AKI in the world was estimated at 2.3%.[14] About 20% of our AKI patients required hemodialysis support. It was relatively higher in our study which could be attributed to different etiological causes of AKI. Most of our patients (approximately 81%) required hospitalization for around or <2 weeks. About 7% of patients required hospitalization for >3 weeks. Mean duration of hospitalization was 11.01 ± 8.60 days. In another study by Kumar et al., the mean duration of hospital stay was 9.4 days. Overall mortality was around 18.58% in our study as compared to 29.2% in a study by Kumar et al.[13]

The high mortality rate associated with AKI is alarming. Timely diagnosis and the management of this disease condition confer a favorable prognosis to the patient. The progression of AKI lead to increased hospital mortality rates and increased the length of stays that might prove wastage of limited resources in a setting like India. Hence, more number of studies have to be done to efficiently pinpoint the predictors of AKI and preventing its occurrence in near future.


  Conclusion Top


Data on the incidence of AKI from central India are scarce. This showed that AKI is a frequent condition in the central part of India. Most patients recovered their renal function, but the mortality rate of 18.58% is concerning. Prevention, early recognition, and treatment of causative factors remain the key to reduce incidence and mortality due to AKI. This study helps in determining local factors contributing toward AKI.

Limitation

Limitation is that the study was carried out in a single referral tertiary hospital.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: A global perspective of a silent killer. Kidney Int 2013;84:457-67.  Back to cited text no. 1
    
2.
Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: An increasing global concern. Lancet 2013;382:170-9.  Back to cited text no. 2
    
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Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16:3365-70.  Back to cited text no. 3
    
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Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 2011;79:1361-9.  Back to cited text no. 4
    
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Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: A systematic review and meta-analysis. Kidney Int 2012;81:442-8.  Back to cited text no. 5
    
6.
Ishani A, Nelson D, Clothier B, Schult T, Nugent S, Greer N, et al. The magnitude of acute serum creatinine increase after cardiac surgery and the risk of chronic kidney disease, progression of kidney disease, and death. Arch Intern Med 2011;171:226-33.  Back to cited text no. 6
    
7.
Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Inter Suppl 2012;2:1-38.  Back to cited text no. 7
    
8.
Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-7.  Back to cited text no. 8
    
9.
Chindarkar NS, Chawla LS, Straseski JA, Jortani SA, Uettwiller-Geiger D, Orr RR, et al. Demographic data for urinary acute kidney injury (AKI) marker [IGFBP7]·[TIMP2] reference range determinations. Data Brief 2015;5:888.  Back to cited text no. 9
    
10.
Osman M, Shigidi M, Ahmed H, Abdelrahman I, Karrar W, Elhassan E, et al. Pattern and outcome of acute kidney injury among Sudanese adults admitted to a tertiary level hospital: A retrospective cohort study. Pan Afr Med J 2017;28:90.  Back to cited text no. 10
    
11.
Ghimire M, Pahari B, Sharma SK, Thapa L, Das G, Das GC, et al. Outcome of sepsis-associated acute kidney injury in an intensive care unit: An experience from a tertiary care center of central Nepal. Saudi J Kidney Dis Transpl 2014;25:912-7.  Back to cited text no. 11
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12.
Lee FY, Chen WK, Lin CL, Lai CY, Wu YS, Lin IC, et al. Organophosphate poisoning and subsequent acute kidney injury risk: A nationwide population-based cohort study. Medicine (Baltimore) 2015;94:e2107.  Back to cited text no. 12
    
13.
Kumar S, Raina S, Vikrant S, Patial RK. Spectrum of acute kidney injury in the Himalayan region. Indian J Nephrol 2012;22:363-6.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, et al. World incidence of AKI: A meta-analysis. Clin J Am Soc Nephrol 2013;8:1482-93.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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