A Prospective Observational study of the Pattern of Acute Kidney Injury and Its Outcome seen in Medical Wards in a Tertiary Care Hospital

BACKGROUND: AKI (Acute Kidney Injury) is defined as an abrupt (within hours) decrease in kidney function, which encompasses both injury (structural damage) and impairment (loss of function). Acute Kidney Injury (AKI) is the consensus term for Acute Renal Failure (ARF). Despite the advances in renal replacement therapy, the mortality in AKI remained more or less same in the past five decades. However, it is very important to know the epidemiology and clinical features of AKI, so as to execute adequate means for handling the problem and to boost preventive strategy which are based on a referral to a renal replacement therapy unit and hence the current study was conducted. OBJECTIVES: Among all the in patients admitted in the medical wards. 1. To estimate the prevalence, etiology and severity of AKI. 2. To apply the KDIGO criteria in AKI patients admitted to the medical wards and to confirm its significance. 3. To study the outcomes of AKI and to assess the need of renal replacementtherapy in AKI. 4. To study the risk and prognostic factors of AKI. METHODS: Facility based descriptive study design to study the incidence of AKI, etiology, severity, the application of KDIGO criteria and the outcome of AKI patients. All in- patients above the age of 15 years with clinical and / or biochemical evidence of acute kidney injury. They were subjected to pretested semi-structured questionnaire. Appropriate operational definition were adopted. Data entered in excel and analysed using STATA Version 14. Continuous variable such as age and blood investigation values were summarised as mean (Standard deviation) or median (Interquartile range) based on distribution. Categorical variables like incidence of AKI, Gender were summarised as proportions with 95% Confidence Interval. RESULTS: In the current study, participants were in the age group from 15 years to >60 years. Majority of the study participants stayed between five and eight days in the hospital. Around 65% of the study participants had complaints of oliguria followed by vomiting and loose stools in 64%and 57% respectively. Diabetes Mellitus (44%) was the most common associated comorbidity followed by hypertension and COPD among the study participants. Hemoglobin value of the study participants was 10.5 (1.2). The mean (SD) urea value of the study participants was 93.3(37). The mean (SD) creatinine value of the study participants was 4(2.4).The mean (SD) sodium value of the study participants 134.3 (3.9). The mean (SD) potassium value of the study participants 3.4 (0.5). Hemodialysis was the most common mode (70%) of renal replacement therapy followed by peritoneal dialysis (30%). In our study around 41% of the study participants were in stage 2 followed by stage 3 (34%) and stage 1 (25%). The most common causes of AKI were acute diarrhoeal diseases (54%), snake bite (26%), sepsis (12%), methanol poisoning (9%). CONCLUSIONS: More than 90% of the AKI patients recovered completely. Among the clinical presentation of the study participants at the time of diagnosis, the association was found between the presenting condition and the outcome of AKI. It was found that dyspnea, altered mental status, jaundice and pedal edema was found to statistically significant. The association between type of dialysis and outcome of AKI was found to be statistically significant