Original Article
Spectrum of acute kidney injury in critically ill patients: A single center study from South India M. Eswarappa, M. S. Gireesh, V. Ravi, D. Kumar, G. Dev Department of Nephrology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
ABSTRACT Acute kidney injury (AKI) is common in intensive care unit (ICU) and carries a high mortality rate. Reliable and comparable data about the clinical spectrum of AKI is necessary for optimizing management. The study was conducted to describe epidemiology, etiology, clinical characteristics and outcome of AKI in critically ill patients without pre‑existing renal disease, diagnosed using RIFLE criteria. We retrospectively analyzed data of 500 adult patients admitted to ICU with AKI or who developed AKI in ICU. Patients with pre‑existing renal disease, renal transplant recipients were excluded. AKI was predominantly encountered in older males. Diabetes, hypertension, coronary artery disease were the most commonly prevalent comorbidities. Sepsis was the most common cause of AKI, accounting for 38.6% of patients. 24.4% belonged to risk class, 37.0% to injury class, 35.0% to failure class, 3% to loss and 0.6% to ESRD class of the RIFLE criteria. Renal replacement therapy (RRT) was required in 37.2% (n = 186) of patients. About 60% recovered complete renal function. Chronic kidney disease (CKD) was a sequel in 2.4% (n = 12) of patients. Average duration of ICU stay was 5.6 days. Crude mortality rate was 37.6% (n = 188). In critically ill patients without pre‑existing renal disease, elderly age, male sex, type 2 diabetes along with a primary diagnosis of sepsis were most commonly associated with AKI. Majority of the patients’ recovered complete renal function. Key words: Acute kidney injury, critically ill patients, end stage criteria, failure, India, injury, loss, risk, spectrum
Introduction Acute kidney injury (AKI) is a new consensus term, encompassing a range of kidney diseases of acute onset.[1‑3] Two trials, namely program to improve care in acute renal disease (PICARD) and beginning and ending supportive therapy (BEST) for the kidney, confirmed that AKI is a significant contributor toward mortality, morbidity among ICU patients.[4‑6] RIFLE classification scheme and acute kidney injury network (AKIN) classification scheme have been proposed to achieve early diagnosis of AKI.[7] A new Address for correspondence: Dr. M. Eswarappa, Department of Nephrology, M. S. Ramaiah Medical College, MSRIT Post, MSR Nagar, Bengaluru ‑ 560 054, Karnataka, India. E‑mail: [email protected] Access this article online Quick Response Code:
Website: www.indianjnephrol.org DOI: 10.4103/0971-4065.132991
280
Sep 2014 / Vol 24 / Issue 5
consensus definition merging the criteria has also emerged from the Kidney Disease Improving Global Outcomes.[8] With the application of these criteria, prevalence of AKI in ICU setting is >40% if sepsis is present and the mortality rates varied from 15% to 60%.[9,10] Longer hospital stay and economic burden are inevitable. In contrast to western literature, few reliable statistics are available regarding AKI in India.[11] We retrospectively evaluated patients with AKI, using the RIFLE criteria, to answer questions regarding most susceptible population, etiology, role of dialysis, outcomes and relation of mortality rate with RIFLE class.
Subjects and Methods The study was conducted by Nephrology Department of our teaching hospital, a tertiary level referral center in South India, during the period of May 2011 to October 2012. A total of 500 patients with AKI during this period, who met our study requirements were evaluated retrospectively. A total of 8621 patients were admitted to the ICU during this period. Definitions AKI was defined as patients whose serum creatinine and/or urine output fulfilled the RIFLE criteria. Risk class was Indian Journal of Nephrology
Eswarappa, et al.: Spectrum of acute kidney injury in critically ill patients
Inclusion and exclusion criteria All patients aged above 18 years admitted to ICU with AKI and those who developed AKI after admission to ICU, during the period of May 2011 to October 2012, were included in our study. Patients with preexisting renal disease and those who received renal transplantation were excluded from the study. A total of 500 patients met the above requirements and were evaluated retrospectively. Data collection We retrospectively retrieved the required data from the patient files in medical records department using a standardized proforma developed for the study. Demographic information retrieved included age, sex, weight, height, duration of ICU and hospital stay. Clinical data retrieved included primary diagnosis, past medical history, presence of co‑morbidities, surgical status, physical examination findings, lab investigations, treatment history, hospital course and need for renal replacement therapy (RRT). Baseline and peak levels of serum creatinine, urine output were collected. Data regarding laboratory investigations were collected to confirm the etiology of AKI, which included complete urine analysis, metabolic panel, lipid profile, blood culture, hematologic profile, coagulation profile. Radiological tests, serological tests and renal biopsy findings when available were also retrieved. Follow‑up data regarding their renal function was also collected. We then analyzed the pooled data to come to our conclusions. The duration of follow‑up was 3 months. There was no loss to follow‑up of the patients. Statistical calculations were done using Indian Journal of Nephrology
Chi‑square test as and when required. P < 0.05 was considered to be significant. The calculations were carried out using SPSS (statistical package for the social sciences) 16.0 statistical software (IBM SPSS, Chicago, Illinois) when required. We compared our results to existing data available using PUBMED database.
Results Etiology Among the patients (n = 500) enrolled in our study, most common cause of AKI was sepsis. Urinary tract infections were the most common source of sepsis, followed by respiratory infections and diabetic foot. Gastroenteritis was the second most common cause of AKI in our study. Obstetrical diseases were the third most common cause of AKI while surgical, hepatic and cardiac disease constituted the other major causes. Malaria, dengue, leptospirosis, Drug induced AKI, snake bite, H1N1 influenza, Multiple myeloma, RPGN were the other causes of AKI, although less common. Hair dye poisoning accounted for 3 cases, organophosphates accounted for two cases. The observations regarding the etiology of AKI in our study are summarized in Table 1. Epidemiology One‑fourth (n = 125) of the patients developed HAAKI and the remaining presented with CAAKI. Majority of patients with AKI belonged to the age group of 61‑70 years accounting for 22.8% (n = 114) of total patients [Figure 1]. The median age of the patients was 55.5 years, lying in the age group of 51‑60 years. Figure 1 illustrates these observations. AKI was more commonly associated with male sex, 63.6% (n = 318) of the patients were males. Type 2 diabetes was the most common comorbidity followed by hypertension and coronary artery disease. Chronic liver disease, $.,GLVWULEXWLRQLQUHODWLRQWRSDWLHQWDJH
1XPEHURISDWLHQWVZLWK$.,
defined as increase in serum creatinine ≥1.5 × baseline or urine output 60, male gender were prevalent in the majority of AKI patients. More than 60% of the patients had associated comorbidities, with type 2 diabetes, hypertension and coronary artery disease being the three most common. Majority of the patients did not require RRT and were treated conservatively. About, 60% of the total patients recovered normal renal function, with 2.4% of the total patients developing CKD. Crude mortality rate among patients with AKI in our study group was 37.6%. Indian Journal of Nephrology
Eswarappa, et al.: Spectrum of acute kidney injury in critically ill patients
References 1. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet 2012;380:756‑66. 2. Kes P, Basić Jukić N. Acute kidney injury in the intensive care unit. Bosn J Basic Med Sci 2010;10 Suppl 1:S8‑12. 3. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. 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. Crit Care 2004;8:R204‑12. 4. Pisoni R, Wille KM, Tolwani AJ. The epidemiology of severe acute kidney injury: From BEST to PICARD, in acute kidney injury: New concepts. Nephron Clin Pract 2008;109:c188‑91. 5. Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, et al. An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and management of acute renal failure in the ICU patient: An international consensus conference in intensive care medicine. Am J Respir Crit Care Med 2010;181:1128‑55. 6. Faber P, Klein AA. Acute kidney injury and renal replacement therapy in the intensive care unit. Nurs Crit Care 2009;14:207‑12. 7. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31. 8. The Kidney Disease Improving Global Outcomes (KDIGO) Working Group. Definition and classification of acute kidney injury. Kidney Int 2012;Volume 2, issue 1, Suppl 2:19‑36. 9. Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committee. Early acute kidney injury and sepsis: A multicentre evaluation. Crit Care 2008;12:R47. 10. Kellum JA, Bellomo R, Ronco C. Definition and classification of acute kidney injury. Nephron Clin Pract 2008;109:c182‑7. 11. Sakhuja V, Sud K. Acute renal failure in the tropics. Saudi J Kidney Dis Transpl 1998;9:247‑60. 12. Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract 2013;2013:479730. 13. Paudel MS, Wig N, Mahajan S, Pandey RM, Guleria R, Sharma SK. A study of incidence of AKI in critically ill patients. Ren Fail 2012;34:1217‑22. 14. Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 2009;35:1692‑702. 15. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005;294:813‑8. 16. Cartin‑Ceba R, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET. Risk factors for development of acute kidney injury in critically ill patients: A systematic review and meta‑analysis of observational studies. Crit Care Res Pract 2012;2012:691013.
Indian Journal of Nephrology
17. Hoste EA, Kellum JA. Acute kidney injury: Epidemiology and diagnostic criteria. Curr Opin Crit Care 2006;12:531‑7. 18. OECD (2010), “OECD Factbook 2006”, OECD Factbook Statistics (database). doi: 10.1787/data‑00374‑en [Last accessed on 2014 Feb 10]. 19. Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, et al. Incidence and outcomes in acute kidney injury: A comprehensive population‑based study. J Am Soc Nephrol 2007;18:1292‑8. 20. Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2:431‑9. 21. Singbartl K, Kellum JA. AKI in the ICU: Definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012;81:819‑25. 22. Jha V, Malhotra HS, Sakhuja V, Chugh KS. Spectrum of hospital‑acquired acute renal failure in the developing countries-Chandigarh study. Q J Med 1992;83:497‑505. 23. Prakash J, Singh SP, Kumar OM, Malhotra V, Tripathi K, Srivastava PK. Hospital acquired acute renal failure. Indian J Nephrol 1996;6:9‑13. 24. Singh TB, Rathore SS, Choudhury TA, Shukla VK, Singh DK, Prakash J. Hospital‑acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study. Indian J Nephrol 2013;23:24‑9. 25. Mahajan S, Tiwari S, Bharani R, Bhowmik D, Ravi S, Agarwal SK, et al. Spectrum of acute renal failure and factors predicting its outcome in an intensive care unit in India. Ren Fail 2006;28:119‑24. 26. Kaul A, Sharma RK, Tripathi R, Suresh KJ, Bhatt S, Prasad N. Spectrum of community‑acquired acute kidney injury in India: A retrospective study. Saudi J Kidney Dis Transpl 2012;23:619‑28. 27. Shah PR, Gireesh MS, Kute VB, Vanikar AV, Gumber MR, Patel HV, et al. Renal involvement in sepsis: A prospective single‑center study of 136 cases. Saudi J Kidney Dis Transpl 2013;24:620‑9. 28. Palevsky PM. Renal replacement therapy in acute kidney injury. Adv Chronic Kidney Dis 2013;20:76‑84. 29. Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med 1995;155:1505‑11. 30. Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committe. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569‑74. 31. Schiffl H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: A prospective study in critically ill patients. Nephrol Dial Transplant 2006;21:1248‑52. How to cite this article: Eswarappa M, Gireesh MS, Ravi V, Kumar D, Dev G. Spectrum of acute kidney injury in critically ill patients: A single center study from South India. Indian J Nephrol 2014;24:280-5. Source of Support: Nil, Conflict of Interest: None declared.
Sep 2014 / Vol 24 / Issue 5
285
Copyright of Indian Journal of Nephrology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Spectrum of acute kidney injury in critically ill patients: A single center study from South India M. Eswarappa, M. S. Gireesh, V. Ravi, D. Kumar, G. Dev Department of Nephrology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
ABSTRACT Acute kidney injury (AKI) is common in intensive care unit (ICU) and carries a high mortality rate. Reliable and comparable data about the clinical spectrum of AKI is necessary for optimizing management. The study was conducted to describe epidemiology, etiology, clinical characteristics and outcome of AKI in critically ill patients without pre‑existing renal disease, diagnosed using RIFLE criteria. We retrospectively analyzed data of 500 adult patients admitted to ICU with AKI or who developed AKI in ICU. Patients with pre‑existing renal disease, renal transplant recipients were excluded. AKI was predominantly encountered in older males. Diabetes, hypertension, coronary artery disease were the most commonly prevalent comorbidities. Sepsis was the most common cause of AKI, accounting for 38.6% of patients. 24.4% belonged to risk class, 37.0% to injury class, 35.0% to failure class, 3% to loss and 0.6% to ESRD class of the RIFLE criteria. Renal replacement therapy (RRT) was required in 37.2% (n = 186) of patients. About 60% recovered complete renal function. Chronic kidney disease (CKD) was a sequel in 2.4% (n = 12) of patients. Average duration of ICU stay was 5.6 days. Crude mortality rate was 37.6% (n = 188). In critically ill patients without pre‑existing renal disease, elderly age, male sex, type 2 diabetes along with a primary diagnosis of sepsis were most commonly associated with AKI. Majority of the patients’ recovered complete renal function. Key words: Acute kidney injury, critically ill patients, end stage criteria, failure, India, injury, loss, risk, spectrum
Introduction Acute kidney injury (AKI) is a new consensus term, encompassing a range of kidney diseases of acute onset.[1‑3] Two trials, namely program to improve care in acute renal disease (PICARD) and beginning and ending supportive therapy (BEST) for the kidney, confirmed that AKI is a significant contributor toward mortality, morbidity among ICU patients.[4‑6] RIFLE classification scheme and acute kidney injury network (AKIN) classification scheme have been proposed to achieve early diagnosis of AKI.[7] A new Address for correspondence: Dr. M. Eswarappa, Department of Nephrology, M. S. Ramaiah Medical College, MSRIT Post, MSR Nagar, Bengaluru ‑ 560 054, Karnataka, India. E‑mail: [email protected] Access this article online Quick Response Code:
Website: www.indianjnephrol.org DOI: 10.4103/0971-4065.132991
280
Sep 2014 / Vol 24 / Issue 5
consensus definition merging the criteria has also emerged from the Kidney Disease Improving Global Outcomes.[8] With the application of these criteria, prevalence of AKI in ICU setting is >40% if sepsis is present and the mortality rates varied from 15% to 60%.[9,10] Longer hospital stay and economic burden are inevitable. In contrast to western literature, few reliable statistics are available regarding AKI in India.[11] We retrospectively evaluated patients with AKI, using the RIFLE criteria, to answer questions regarding most susceptible population, etiology, role of dialysis, outcomes and relation of mortality rate with RIFLE class.
Subjects and Methods The study was conducted by Nephrology Department of our teaching hospital, a tertiary level referral center in South India, during the period of May 2011 to October 2012. A total of 500 patients with AKI during this period, who met our study requirements were evaluated retrospectively. A total of 8621 patients were admitted to the ICU during this period. Definitions AKI was defined as patients whose serum creatinine and/or urine output fulfilled the RIFLE criteria. Risk class was Indian Journal of Nephrology
Eswarappa, et al.: Spectrum of acute kidney injury in critically ill patients
Inclusion and exclusion criteria All patients aged above 18 years admitted to ICU with AKI and those who developed AKI after admission to ICU, during the period of May 2011 to October 2012, were included in our study. Patients with preexisting renal disease and those who received renal transplantation were excluded from the study. A total of 500 patients met the above requirements and were evaluated retrospectively. Data collection We retrospectively retrieved the required data from the patient files in medical records department using a standardized proforma developed for the study. Demographic information retrieved included age, sex, weight, height, duration of ICU and hospital stay. Clinical data retrieved included primary diagnosis, past medical history, presence of co‑morbidities, surgical status, physical examination findings, lab investigations, treatment history, hospital course and need for renal replacement therapy (RRT). Baseline and peak levels of serum creatinine, urine output were collected. Data regarding laboratory investigations were collected to confirm the etiology of AKI, which included complete urine analysis, metabolic panel, lipid profile, blood culture, hematologic profile, coagulation profile. Radiological tests, serological tests and renal biopsy findings when available were also retrieved. Follow‑up data regarding their renal function was also collected. We then analyzed the pooled data to come to our conclusions. The duration of follow‑up was 3 months. There was no loss to follow‑up of the patients. Statistical calculations were done using Indian Journal of Nephrology
Chi‑square test as and when required. P < 0.05 was considered to be significant. The calculations were carried out using SPSS (statistical package for the social sciences) 16.0 statistical software (IBM SPSS, Chicago, Illinois) when required. We compared our results to existing data available using PUBMED database.
Results Etiology Among the patients (n = 500) enrolled in our study, most common cause of AKI was sepsis. Urinary tract infections were the most common source of sepsis, followed by respiratory infections and diabetic foot. Gastroenteritis was the second most common cause of AKI in our study. Obstetrical diseases were the third most common cause of AKI while surgical, hepatic and cardiac disease constituted the other major causes. Malaria, dengue, leptospirosis, Drug induced AKI, snake bite, H1N1 influenza, Multiple myeloma, RPGN were the other causes of AKI, although less common. Hair dye poisoning accounted for 3 cases, organophosphates accounted for two cases. The observations regarding the etiology of AKI in our study are summarized in Table 1. Epidemiology One‑fourth (n = 125) of the patients developed HAAKI and the remaining presented with CAAKI. Majority of patients with AKI belonged to the age group of 61‑70 years accounting for 22.8% (n = 114) of total patients [Figure 1]. The median age of the patients was 55.5 years, lying in the age group of 51‑60 years. Figure 1 illustrates these observations. AKI was more commonly associated with male sex, 63.6% (n = 318) of the patients were males. Type 2 diabetes was the most common comorbidity followed by hypertension and coronary artery disease. Chronic liver disease, $.,GLVWULEXWLRQLQUHODWLRQWRSDWLHQWDJH
1XPEHURISDWLHQWVZLWK$.,
defined as increase in serum creatinine ≥1.5 × baseline or urine output 60, male gender were prevalent in the majority of AKI patients. More than 60% of the patients had associated comorbidities, with type 2 diabetes, hypertension and coronary artery disease being the three most common. Majority of the patients did not require RRT and were treated conservatively. About, 60% of the total patients recovered normal renal function, with 2.4% of the total patients developing CKD. Crude mortality rate among patients with AKI in our study group was 37.6%. Indian Journal of Nephrology
Eswarappa, et al.: Spectrum of acute kidney injury in critically ill patients
References 1. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet 2012;380:756‑66. 2. Kes P, Basić Jukić N. Acute kidney injury in the intensive care unit. Bosn J Basic Med Sci 2010;10 Suppl 1:S8‑12. 3. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. 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. Crit Care 2004;8:R204‑12. 4. Pisoni R, Wille KM, Tolwani AJ. The epidemiology of severe acute kidney injury: From BEST to PICARD, in acute kidney injury: New concepts. Nephron Clin Pract 2008;109:c188‑91. 5. Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, et al. An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and management of acute renal failure in the ICU patient: An international consensus conference in intensive care medicine. Am J Respir Crit Care Med 2010;181:1128‑55. 6. Faber P, Klein AA. Acute kidney injury and renal replacement therapy in the intensive care unit. Nurs Crit Care 2009;14:207‑12. 7. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31. 8. The Kidney Disease Improving Global Outcomes (KDIGO) Working Group. Definition and classification of acute kidney injury. Kidney Int 2012;Volume 2, issue 1, Suppl 2:19‑36. 9. Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committee. Early acute kidney injury and sepsis: A multicentre evaluation. Crit Care 2008;12:R47. 10. Kellum JA, Bellomo R, Ronco C. Definition and classification of acute kidney injury. Nephron Clin Pract 2008;109:c182‑7. 11. Sakhuja V, Sud K. Acute renal failure in the tropics. Saudi J Kidney Dis Transpl 1998;9:247‑60. 12. Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract 2013;2013:479730. 13. Paudel MS, Wig N, Mahajan S, Pandey RM, Guleria R, Sharma SK. A study of incidence of AKI in critically ill patients. Ren Fail 2012;34:1217‑22. 14. Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 2009;35:1692‑702. 15. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005;294:813‑8. 16. Cartin‑Ceba R, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET. Risk factors for development of acute kidney injury in critically ill patients: A systematic review and meta‑analysis of observational studies. Crit Care Res Pract 2012;2012:691013.
Indian Journal of Nephrology
17. Hoste EA, Kellum JA. Acute kidney injury: Epidemiology and diagnostic criteria. Curr Opin Crit Care 2006;12:531‑7. 18. OECD (2010), “OECD Factbook 2006”, OECD Factbook Statistics (database). doi: 10.1787/data‑00374‑en [Last accessed on 2014 Feb 10]. 19. Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, et al. Incidence and outcomes in acute kidney injury: A comprehensive population‑based study. J Am Soc Nephrol 2007;18:1292‑8. 20. Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2:431‑9. 21. Singbartl K, Kellum JA. AKI in the ICU: Definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012;81:819‑25. 22. Jha V, Malhotra HS, Sakhuja V, Chugh KS. Spectrum of hospital‑acquired acute renal failure in the developing countries-Chandigarh study. Q J Med 1992;83:497‑505. 23. Prakash J, Singh SP, Kumar OM, Malhotra V, Tripathi K, Srivastava PK. Hospital acquired acute renal failure. Indian J Nephrol 1996;6:9‑13. 24. Singh TB, Rathore SS, Choudhury TA, Shukla VK, Singh DK, Prakash J. Hospital‑acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study. Indian J Nephrol 2013;23:24‑9. 25. Mahajan S, Tiwari S, Bharani R, Bhowmik D, Ravi S, Agarwal SK, et al. Spectrum of acute renal failure and factors predicting its outcome in an intensive care unit in India. Ren Fail 2006;28:119‑24. 26. Kaul A, Sharma RK, Tripathi R, Suresh KJ, Bhatt S, Prasad N. Spectrum of community‑acquired acute kidney injury in India: A retrospective study. Saudi J Kidney Dis Transpl 2012;23:619‑28. 27. Shah PR, Gireesh MS, Kute VB, Vanikar AV, Gumber MR, Patel HV, et al. Renal involvement in sepsis: A prospective single‑center study of 136 cases. Saudi J Kidney Dis Transpl 2013;24:620‑9. 28. Palevsky PM. Renal replacement therapy in acute kidney injury. Adv Chronic Kidney Dis 2013;20:76‑84. 29. Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med 1995;155:1505‑11. 30. Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committe. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569‑74. 31. Schiffl H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: A prospective study in critically ill patients. Nephrol Dial Transplant 2006;21:1248‑52. How to cite this article: Eswarappa M, Gireesh MS, Ravi V, Kumar D, Dev G. Spectrum of acute kidney injury in critically ill patients: A single center study from South India. Indian J Nephrol 2014;24:280-5. Source of Support: Nil, Conflict of Interest: None declared.
Sep 2014 / Vol 24 / Issue 5
285
Copyright of Indian Journal of Nephrology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
