Profile of Community-Acquired Acute Kidney Injury Defined Using RIFLE Criteria Among Medical In-Patients: A Prospective Descriptive Single Centre Study

Aim: To determine the proportion of patients who have Acute Kidney Injury (AKI), identify severity of AKI using RIFLE criteria and to identify associated factors with AKI.

Methods: One thousand consecutive medical in-patients were screened for AKI and severity assessed using RIFLE criteria in tertiary care hospital in Northern India. Patients with medical renal disease and obstructive uropathy were excluded. Serum creatinine of all patients were done on days 0, 3, 7 and 14. CKD cases were also excluded. AKI patients were followed at 4 weeks and 3 months.

Results: Amongst 1000 patients screened, 65 had AKI. 27(41.5%), 15(23.0%) and 23(35.38%) patients belonged to risk, injury and failure classes of AKI respectively as per RIFLE criteria, and there was incremental risk of mortality (25.92%, 46.33% and 86.95%, p<0.001). In-patients with pneumonia, chronic liver disease and acute gastroenteritis have greater odds of developing AKI, with chronic liver disease having a high mortality (90%). Hypotension (OR- 5.5:1, p=0.002) or leucocytosis at presentation (OR-2.8:1, p<0.001), smokers (OR-2.2:1, p=0.03) and alcoholics (OR-2.5:1, p=0.047) had greater odds of developing AKI. 33(50.7%) patients with AKI died and 27(41.5%) recovered before day 28. Five (7.7%) were seen in class L who had persistently elevated creatinine at day 90 i.e. progressed to ESRD, class E.

Conclusion: The incidence of AKI among medical in-patients was 6.5%, with an incremental risk of mortality in risk, injury and failure classes. Pneumonia and acute gastroenteritis among infections and chronic liver disease have greater odds of developing AKI. Hypotension, leucocytosis, smoking, alcohol and aetiology are independent risk factors for AKI.