The Determinants and Outcome of Acute Kidney Injury in Critically Ill Patients on Zagazig University Hospitals

BACKGROUND Acute kidney injury (AKI) is a common and serious complication in hospitalized patients particularly in patients in the intensive care unit (ICU). The mortality rate in patients with AKI remains very high, despite significant advances in the care of critically ill patients. The identification of risk factors associated with AKI and its poor prognosis is required, so preventive and early diagnostic measures can be taken, aiming to reduce patients' mortality and to improve the outcome. OBJECTIVE This study was to evaluate the prevalence of AKI in patients admitted to ICU as well as to identify the risk factors that affect the occurrence and the outcome of AKI in those patients. METHODS We screened 238 patients admitted to Zagazig university hospitals ICU for the occurrence and determinants of AKI during their period of admission. All patients were subjected to full history taking with special attention to hypertension (HTN), diabetes mellitus (DM), underlying chronic kidney disease (CKD) and drug intake, thorough clinical examination with special attention to the presence of sepsis, Acute Physiology And Chronic Health Evaluation (APACHE II score) during the first 24 hours of admission, time of nephrology consultation and the need for renal replacement therapy (RRT). Laboratory investigations included complete blood count, liver function tests, renal function tests, coagulation profile (PT, PTT, and INR), ABG, serum Mg, Calcium and Phosphorus levels and complete urine analysis. RESULTS The prevalence of AKI in critically ill patients admitted to Zagazig University ICU was 35.3%, of them 14.2% developed end stage renal disease (ESRD) and the mortality rate was 13%. Sepsis was the most common cause of AKI and its prevalence was 51.2%. Hypomagnesaemia, oliguria, late nephrology consultation, duration of AKI greater than2weeks, need for RRT, underlying CKD, Agegreater than60years, APACHE II score greater than15, patients with stage 3 AKI according to acute kidney injury network (AKIN) criteria, oliguria and sepsis, all are risk factors associated with increased risk of non-recovery of renal function. Thrombocytopenia2weeks, need for RRT, late nephrology consultation, sepsis, agegreater than60years and APACHE II score greater than15 are risk factors associated with increased risk of mortality. Late nephrology consultation and stage 3 AKI were the most important risk factors for overall unfavorable outcome (ESRD and death). CONCLUSION AKI is very prevalent in critically ill patients with sepsis being the most common cause. Late nephrology consultation and stage 3 AKI are the most important independent risk factors for unfavorable outcome in those patients.