Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India.
Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India.
Ann Afr Med. 2024 Jul 1;23(3):420-428. doi: 10.4103/aam.aam_110_23. Epub 2024 Jul 20.
In this observational study, clinical characteristics, etiologies, and outcomes of patients admitted to the hospital with community-acquired acute kidney injury (CAAKI) have been compared in contrast to those who hospital-acquired Acute Kidney Injury (HAAKI).
This was a prospective study of adults aged 18 years or above diagnosed with acute kidney injury (AKI) over a period of 17 months at a tertiary care hospital.
230 patients had AKI with the mean age of the study population being 45.33 ± 12.68 years. 178 (77.4%) patients were enrolled from medical unit, 25 (10.7%) from surgical unit, and 27 (11.7%) from obstetrical unit. The observed incidence of AKI was 15/1000 admissions. About 58.2% had CAAKI and 96 (43.7%) had HAAKI. Out of 230 patients, 170 (73.9%) patients were male and 60 (26.1%) were female. Sepsis was the most common (52.1%) etiology of AKI among the medical cases. Urosepsis, scrub typhus, and pneumonia were the most common causes of AKI. Sixty percent of AKI was Kidney Disease Improving Global Outcomes Stage 1 or 2 and 40% was in Stage 3. Oliguria was seen in 56.5%, hyperkalemia in 34.7%, fluid overload in 6.1%, and metabolic acidosis in 22.6%. The majority of patients had multiple organ involvement (52.1%) at the time of enrollment. About 116 (50.4%) had lung injury requiring mechanical ventilation and 95 (41.3%) were on inotropes. Mortality occurred in 19.5%. Anemia, the use of vasopressor drugs, and the need for intensive care support were independent predictive factors for mortality.
AKI was common in hospitalized patients and leads to significant inhospital mortality. AKI is largely a CAAKI, and the lesser extent is due to HAAKI. Many causes are potentially preventable. Early fluid resuscitation, effective antibiotics, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.
在这项观察性研究中，比较了因社区获得性急性肾损伤（CAAKI）而住院的患者与因医院获得性急性肾损伤（HAAKI）而住院的患者的临床特征、病因和结局。
这是一项在一家三级保健医院进行的为期 17 个月的成人急性肾损伤（AKI）的前瞻性研究。
230 例患者 AKI，研究人群的平均年龄为 45.33 ± 12.68 岁。178 例（77.4%）患者来自内科病房，25 例（10.7%）来自外科病房，27 例（11.7%）来自产科病房。观察到 AKI 的发生率为 15/1000 例住院患者。约 58.2%为 CAAKI，96 例（43.7%）为 HAAKI。在 230 例患者中，170 例（73.9%）为男性，60 例（26.1%）为女性。内科患者中，败血症是 AKI 最常见的病因（52.1%）。尿路感染、恙虫病和肺炎是 AKI 的最常见病因。60%的 AKI 为肾脏病改善全球结局（KDIGO）第 1 或 2 期，40%为第 3 期。少尿 56.5%，高钾血症 34.7%，液体超负荷 6.1%，代谢性酸中毒 22.6%。大多数患者在入组时存在多个器官受累（52.1%）。116 例（50.4%）患者需要机械通气治疗肺损伤，95 例（41.3%）患者使用正性肌力药物。死亡率为 19.5%。贫血、使用血管加压药物和需要重症监护支持是死亡的独立预测因素。
AKI 在住院患者中很常见，导致显著的院内死亡率。AKI 主要是 CAAKI，较少程度是由 HAAKI 引起的。许多病因是潜在可预防的。早期液体复苏、有效抗生素、适当解毒剂以及及时将确诊 AKI 患者转诊至有透析设施的中心，可改善 AKI 结局。
