Unraveling the Roots: Investigating Etiological Patterns of Acute Kidney Injury in Hospitalized Patients at Khyber Teaching Hospital, Peshawar, Pakistan

Authors

  • Ali Raza Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Samra Suhail Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Muhammad Noman Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Ulfat Nisa Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Aaliyan Khattak Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Faizan Banaras Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v2i02.162

Abstract

Background

Acute kidney injury (AKI) is the main cause of poor outcomes for patients. AKI affects about 13.3 million individuals worldwide annually with eight-five percent living in nations that are developing.

Methodology

It was a cross-sectional study. 74 patients were included in the study. AKI was diagnosed using the RIFLE criteria, based on serum creatinine levels. Hospital acquired acute kidney injury (HAAKI) was defined as the onset of AKI occurring any time after 48 hours of hospitalization in patients who were admitted with normal renal function. Data was collected from patient records, such as demographics, and clinical history. Variables were reported as mean ± SD. Statistical calculation was done using Chi‐square test. P < 0.05 was considered significant. All the calculations were carried out with the help of software IBM SPSS STATISTICS 25 version.

Results

This study underscores the impact of HAAKI on patient outcomes, affecting all age groups, with a majority of cases among individuals under 50. The findings highlight infections and trauma, notably sepsis and hypotension, as major causes, making up over two-thirds of HAAKI cases. The severity of kidney injury, classified by the RIFLE criteria, was directly correlated with increased mortality and the need for dialysis, especially for patients in the "Failure" category. Survival outcomes were notably higher for those in the "Risk" stage compared to the "Injury" and "Failure" stages, which experienced higher mortality. This emphasizes the necessity for early detection and management of patients with progressing kidney injury to prevent progression to critical stages. Timely intervention could potentially reduce mortality and improve overall outcomes for HAAKI patients.

Conclusion

This study highlights HAAKI has significant impact on patient outcomes, showing that sepsis and hypotension are major causes. Mortality risk escalates with RIFLE category severity, particularly in the “Failure” stage. Early identification and proactive management are essential to reduce progression, improve survival, and enhance patient outcomes in HAAKI cases.

Author Biographies

Ali Raza, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

Postgraduate Resident Nephrology

Samra Suhail, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

Postgraduate Resident Nephrology

Muhammad Noman, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

House Officer

Ulfat Nisa, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

House Officer

Aaliyan Khattak, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

House Officer

Faizan Banaras, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

Postgraduate Resident Nephrology

References

Mehta, R. L., Cerdá, J., Burdmann, E. A., Tonelli, M., García-García, G., Jha, V., Susantitaphong, P., Rocco, M., Vanholder, R., Sever, M. S., Cruz, D., Jaber, B., Lameire, N. H., Lombardi, R., Lewington, A., Feehally, J., Finkelstein, F., Levin, N., Pannu, N., … Remuzzi, G. (2015). International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet, 385(9987), 2616–2643. https://doi.org/10.1016/S0140-6736(15)60126-X

Susantitaphong, P., Cruz, D. N., Cerda, J., Abulfaraj, M., Alqahtani, F., Koulouridis, I., Jaber, B. L., & Acute Kidney Injury Advisory Group of the American Society of Nephrology. (2013). World incidence of AKI: a meta-analysis: A meta-analysis. Clinical Journal of the American Society of Nephrology: CJASN, 8(9), 1482–1493. https://doi.org/10.2215/CJN.00710113

Bellomo, R., Ronco, C., Kellum, J. A., Mehta, R. L., Palevsky, P., & Acute Dialysis Quality Initiative workgroup. (2004). Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care (London, England), 8(4), R204-12. https://doi.org/10.1186/cc2872

Uchino, S. (2005). Acute renal failure in critically ill PatientsA multinational, multicenter study. JAMA: The Journal of the American Medical Association, 294(7), 813. https://doi.org/10.1001/jama.294.7.813

Liangos, O., Wald, R., O’Bell, J. W., Price, L., Pereira, B. J., & Jaber, B. L. (2006). Epidemiology and outcomes of acute renal failure in hospitalized patients: A national survey. Clinical Journal of the American Society of Nephrology: CJASN, 1(1), 43–51. https://doi.org/10.2215/cjn.00220605

Brivet, F. G., Kleinknecht, D. J., Loirat, P., & Landais, P. J. (1996). Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality. Critical Care Medicine, 24(2), 192-198. https://doi.org/10.1097/00003246-199602000-00003

Cerdá, J., Bagga, A., Kher, V., & Chakravarthi, R. M. (2008). The contrasting characteristics of acute kidney injury in developed and developing countries. Nature Clinical Practice. Nephrology, 4(3), 138–153. https://doi.org/10.1038/ncpneph0722

Jha, V., & Parameswaran, S. (2013). Community-acquired acute kidney injury in tropical countries. Nature Reviews. Nephrology, 9(5), 278–290. https://doi.org/10.1038/nrneph.2013.36

Brivet, F. G., Kleinknecht, D. J., Loirat, P., & Landais, P. J. (1996b). Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Critical Care Medicine, 24(2), 192–198. https://doi.org/10.1097/00003246-199602000-00003

Hou, S. H., Bushinsky, D. A., Wish, J. B., Cohen, J. J., & Harrington, J. T. (1983). Hospital-acquired renal insufficiency: a prospective study. The American Journal of Medicine, 74(2), 243–248. https://doi.org/10.1016/0002-9343(83)90618-6

Zeng, X., McMahon, G. M., Brunelli, S. M., Bates, D. W., & Waikar, S. S. (2014). Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clinical Journal of the American Society of Nephrology: CJASN, 9(1), 12–20. https://doi.org/10.2215/CJN.02730313

Chawla, L. S., Eggers, P. W., Star, R. A., & Kimmel, P. L. (2014). Acute kidney injury and chronic kidney disease as interconnected syndromes. The New England Journal of Medicine, 371(1), 58–66. https://doi.org/10.1056/NEJMra1214243

Ishani, A., Xue, J. L., Himmelfarb, J., Eggers, P. W., Kimmel, P. L., Molitoris, B. A., & Collins, A. J. (2009). Acute kidney injury increases risk of ESRD among elderly. Journal of the American Society of Nephrology: JASN, 20(1), 223–228. https://doi.org/10.1681/ASN.2007080837

Coca, S. G., Singanamala, S., & Parikh, C. R. (2012). Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney International, 81(5), 442–448. https://doi.org/10.1038/ki.2011.379

Uchino, S., Kellum, J. A., Bellomo, R., Doig, G. S., Morimatsu, H., Morgera, S., Schetz, M., Tan, I., Bouman, C., Macedo, E., Gibney, N., Tolwani, A., Ronco, C., & Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. (2005). Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA: The Journal of the American Medical Association, 294(7), 813–818. https://doi.org/10.1001/jama.294.7.813

Liangos, O., Wald, R., O’Bell, J. W., Price, L., Pereira, B. J., & Jaber, B. L. (2006b). Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey: A national survey. Clinical Journal of the American Society of Nephrology: CJASN, 1(1), 43–51. https://doi.org/10.2215/CJN.00220605

Spectrum of hospital-acquired acute renal failure in the developing countries— Chandigarh study. (1992). QJM: Monthly Journal of the Association of Physicians. https://doi.org/10.1093/oxfordjournals.qjmed.a068687

Hou, S. H., Bushinsky, D. A., Wish, J. B., Cohen, J. J., & Harrington, J. T. (1983). Hospital-acquired renal insufficiency: a prospective study. The American Journal of Medicine, 74(2), 243–248. https://doi.org/10.1016/0002-9343(83)90618-6

Davidman, M., Olson, P., Kohen, J., Leither, T., & Kjellstrand, C. (1991). Iatrogenic renal disease. Archives of Internal Medicine, 151(9), 1809–1812. https://doi.org/10.1001/archinte.151.9.1809

Abraham, G., Gupta, R. K., Senthilselvan, A., van der Meulen, J., & Johny, K. V. (1989). Cause and prognosis of acute renal failure in Kuwait: a 2-year prospective study. The Journal of Tropical Medicine and Hygiene, 92(5), 325–329.

Sánchez-Sánchez, M., Martínez-Cueto, M., & Mendoza-López, C. (2013). Genetic polymorphisms of glutathione S-transferases and methylenetetrahydrofolate reductase in end-stage renal disease of unknown etiology in Mexican patients. Indian J Nephrol, 23(2), 110–115.

Brivet, F. G., Kleinknecht, D. J., Loirat, P., & Landais, P. J. (1996a). Acute renal failure in intensive care units-causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. Crit Care Med, 24, 192–198.

Hou, S. H., Bushinsky, D. A., Wish, J. B., Cohen, J. J., & Harrington, J. T. (1983). Hospital-acquired renal insufficiency: a prospective study. The American Journal of Medicine, 74(2), 243–248. https://doi.org/10.1016/0002-9343(83)90618-6

Shusterman, N., Strom, B. L., Murray, T. G., Morrison, G., West, S. L., & Maislin, G. (1987). Risk factors and outcome of hospital-acquired acute renal failure. The American Journal of Medicine, 83(1), 65–71. https://doi.org/10.1016/0002-9343(87)90498-0

Downloads

Published

2024-11-16

How to Cite

Raza, A., Suhail, S., Muhammad Noman, Nisa, U., Khattak, A., & Banaras, F. (2024). Unraveling the Roots: Investigating Etiological Patterns of Acute Kidney Injury in Hospitalized Patients at Khyber Teaching Hospital, Peshawar, Pakistan. Indus Journal of Bioscience Research, 2(02), 411–417. https://doi.org/10.70749/ijbr.v2i02.162