Acute Kidney Injury in Critically Ill Patients

Introduction: The assumption that critically ill patient is well defined, promptly recognized and immediately transported in to the Intensive Care Unit (ICU), leads to wrong estimations and erroneous viewpoints of critically ill patient’s epidemiology. The «critically ill» definition neither presupposes his admission in ICU nor precludes his hospitalization in the hospital ward. The purpose of the present study was to evaluate the incidence and risk factors of AKI taking into account the totality of critically ill patients of a given time period . Methods: This is a retrospective study conducted in the general ICU of the University hospital “Attikon”. Participants were adult patients in which an intensivist’s consultation was effectuated by the ICU staff, during a period of 2.5 months. The estimated baseline creatinine was calculated using the MDRD formula, assuming a lower limit of normal baseline glomerular filtration ratio (GFR) of 75ml/min/1.73m2. The presence of AKI was assessed only within the first consultation and was stratified by the three RIFLE categories of severity (Risk, Injury and Failure). The impact on disease’s incidence of demographic characteristics, medical history, clinical data and severity scores of the participants was evaluated. Results: A total of 69 critically ill patients were enrolled in the study. The overall incidence of AKI by the time of 1st consultation was 43% with the women being more frequently and more severely affected. The severity score seemed to be the principal independent risk factor for early AKI occurrence. The adjusted risk of AKI, increased by 14% per unit of increase in the APACHE score (OR 1.12CI 95% 1.03-1.21 P=0.008). Conclusion: Severity score is an independent risk factor of AKI in critically ill patients. Identification of high risk patient and early diagnosis is the only available way to prevent the disease and to improve outcomes.