Acute kidney injury in a Malaysian Intensive Care Unit: incidence, risk factors and outcome

• Main Authors: Md Ralib, Azrina, Mat Nor, Mohd Basri
• Format: Conference or Workshop Item
• Language: English; English
• Published: Singapore-ANZIC 2015
• Subjects: R Medicine (General)
• Online Access: http://irep.iium.edu.my/43431/1/SG-ANZICS_2015.pdf; http://irep.iium.edu.my/43431/4/EPI_AKI_SG-ANZICS_v5.pdf; http://irep.iium.edu.my/43431/

Objectives: Acute Kidney Injury (AKI) is common and carries a high mortality rate. Most epidemiological studies were retrospective and were done in Western populations. To the best of our knowledge, there is no data on the AKI epidemiology based on consensus guideline in our local ICU setting. A prospective study in our population utilising the recent AKI consensus guideline is warranted. This will also allow us to investigate the associated risk factors and outcome. Methods: This was a single centre, prospective observational study. All patients more than 18 years being admitted to ICU and stayed for more than 48 hours were included in the study. The study was registered under the Malaysian National Medical Research Register, and approved by the ethics committee. AKI was defined based on either creatinine (AKICr) or urine output criteria (AKIUO) of the Kidney Disease Improving Global Outcome guideline. Results: One hundred forty three patients were recruited, of these, 93 (65%) had AKI. 13% were Stage 1, 16% Stage 2 and 36% Stage 3. 38% were classified as AKICr, and 61% were classified as AKIuo. Risk factors for AKI includes higher APACHE II Scores, medical category admission and vasopresor therapy (Adjusted OR 1.17 (1.08 to 1.27), 2.95 (1.20 to 7.25), and 2.31 (1.00 to 5.32) respectively). 25% percent of patients received dialysis, and 23% died. AKI was an independent risk factor for death (Adjusted HR 2.61 (1.06 to 6.42)). Conclusions: AKI is common in our ICU, with higher risk of death. Risk factors of AKI include higher severity of illness, medical admission category, and vasopressor therapy. Of those with AKI, almost half are with highest severity, which reflects the late presentation of illness on ICU admission in our population. AKI by the urine output is more sensitive compared to creatinine criteria.