Epidemiology of acute renal injury in the critical care units of a general hospital for acute patients

  • Silvina Maltas Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Luis Touceda Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Maximiliano Malinar Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Juan Agustín Ferrigno Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Nieves Aran Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Lucía Dall’Aglio Palermo Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Cristina Mora Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Matías Melideo Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Jimena Salomone Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Ronald Garzón Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
  • Miriam Del Amo Servicio de Nefrología, Hospital Interzonal General de Agudos San Martín, La Plata
Keywords: acute kidney injury, epidemiology, mortality, critical care, acute renal failure, RIPLE consensus

Abstract

Introduction: Acute kidney injury (AKI) occurs in 1 to 25% of critically ill patients with a morality rate between 15 and 60%. In 2004, the ADQI published the RIFLE consensus definition. Objectives: To evaluate, 1) incidence, evolution and mortality associated with AKI in critical units of HIGA San Martín de La Plata; 2) demographic and clinical characteristics. Methods: We studied patients over 16 years admitted in the UCC from
06/01/2010 to 05/31/2011 hospitalized at least 24 hours and that included two laboratory determinations al least, from entry to day 30 of hospitalization, discharge from the UCC or death. Preexisting pathologies were registered, also previous drug treatments during hospitalization, hemodynamic status, requirement for ARM and biochemical parameters. The IRA was defined according to the RIFLE classification. Results: 290 patients were included, 49.6 x age years, 71% male, etiologies of income: 23.3% cardiovascular, neurological 22.6%, 17.4% trauma and infectious 15.3%. Progression to more severe categories of RIFLE system was observed (p 0.001). The development of AKI was associated with older age (p 0.001) and previous comorbidities (p 0.002). The requirement for HD was 5.17% (15 patients). Mortality was higher with progression in the RIFLE classification (R 46.5% 55.8% I, F 69.2%) and with the requirement of HD (80%). Conclusions: AKI was frequent in UCC, predominantly in older age groups and with comorbidities. The development and progression of renal damage show a correlation with an increased mortality.

References

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative Workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-12.

Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73.

Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007;18(4):1292-8.

Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34(7):1913-7.

Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007;35(8):1837-43.

Murugan R, Karajala-Subramanyam V, Lee M, Yende S, Kong L, Carter M, et al. Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival. Kidney Int. 2010;77(6):527-35.

Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int. 2008;73(5):538-46.

Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23(4):1203-10.

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813-8.

Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50(3):811-8.

Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996;24(2):192-8.

Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM. The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis. 2005;46(6):1038-48.

Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA. Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol. 2003;14(4):1022-30.

Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104(4):343-8.

Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30(9):2051-8.

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813-8.

Elapavaluru S, Kellum JA. Why do patients die of acute kidney injury? Acta Clin Belg. 2007;62(Suppl 2):326-31.

Published
2012-12-09
How to Cite
1.
Maltas S, Touceda L, Malinar M, Ferrigno JA, Aran N, Dall’Aglio Palermo L, Mora C, Melideo M, Salomone J, Garzón R, Del Amo M. Epidemiology of acute renal injury in the critical care units of a general hospital for acute patients. Rev Nefrol Dial Traspl. [Internet]. 2012Dec.9 [cited 2024Dec.23];32(4):189-97. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/225
Issue
Vol. 32 No. 4 (2012): Oct.-Dic.
Section
Original Article