Impact and Incidence of Acute Kidney Injury (AKI) : A One-year Period of Study at a Center Hospital in Thailand
Keywords:
Acute kidney injury (AKI), AKIN (Acute Kidney Injury Network) criteria, Renal replacement therapy (RRT)Abstract
Background and Objective: AKI (acute kidney injury) is a common and serious condition in global countries. The epidemiologic study of AKI in Thailand is currently insufficient. A pilot study as the initiative attempt for the beginning of the epidemiologic data collection in the eastern part of Thailand was set.
Methods: All of Abhaibhubejhr hospital inpatient data during Oct 2011 – Sep 2012 were collected. The AKI patients were defined and classified by AKIN criteria and the renal outcomes were followed for at least 3 months or longer. The purpose of this study was to evaluate the causes, the characteristics and the outcome of AKI in hospitalized Thai patients.
Results: The incidence of AKI was 2.21%. Most of the AKI patients (83%) were diagnosed at the first day of the admission. There were predominantly non-oliguric AKI (78.1%).The three most common causes of AKI were ischemic ATN (46.7%), prerenal AKI (20.4%) and sepsis induced AKI (11.9%).The mortality rate of AKI patients were 41.1% and 3.8% of patients were transferred to academic hospital. Regarding the renal outcome, there were mostly fully recovery (65.1%) or partial recovery (33%), however 1.9% of patients were dialysis dependent. The most common comorbid conditions in AKI patients were septic shock (47%) and congestive heart failure (12.9%). Among true AKI (481 cases), 19.50%, 35% and 49.5% of the patients were classified as AKIN stage 1, AKIN stage 2 and AKIN stage 3, respectively. As expected, severe AKI (AKIN stage 3) patients had higher prevalence of intensive care unit (ICU) admission, renal replacement therapy (RRT) and higher mortality rate compared with other groups. Overall, inpatient with AKI had greater mortality risk (RR 16.84; 95%CI 14.94-18.97), ICU admission rate (RR 7.81; 95%CI 7.00-8.70) and length of stay (2.61 times) compared with inpatient without AKI.
Conclusion: AKI is a common and serious condition in our country. Hemodynamically-mediated AKI (ischemic ATN, prerenal AKI and sepsis induced AKI) are the major causes of AKI in hospitalized patients.
