Epidemiology, clinical profile and outcome of acute kidney injury in intensive coronary care unit

Authors

  • Sharanabasappa . Department of Medicine, RNT Medical College, Udaipur, Rajasthan, India
  • Kartikeya Mathur Department of Gastroenterology, AIIMS, Jodhpur, Rajasthan, India
  • Shivakanth M. Sangapur Department of Medicine, RNT Medical College, Udaipur, Rajasthan, India
  • Baldev Meena Department of Medicine, RNT Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-3259.ijct20232194

Keywords:

AKI, ICCU, CRS, Biomarkers, MI

Abstract

Background: The incidence of AKI in cardiac ICU is attributed mainly to Heart Failure and Acute Coronary Syndrome. AKI occurs commonly in the setting of AHF, and is termed CRS type 1. Biomarkers and bioelectrical impedance analysis can be helpful in estimating the real volume overload and may be useful to predict and avoid AKI. The role of UF remains controversial, and it is currently recommended only for diuretic-resistant patients. Objective of current study was to study demographic & clinical profile and outcome of patients with AKI in intensive coronary care unit.

Methods: This prospective study was conducted in ICCU of R.N.T. Medical College, Udaipur. All the patients with increase in serum creatinine >50% were included in the study. Detailed investigations like urinary analysis, renal function tests (blood urea, serum creatinine, serum electrolytes), USG whole abdomen, 12 lead ECG, Echocardiography and Troponin T.

Results: Among cases 56.67% had ADHF, 25% had MI, 10% had structural heart disease, 3.3% had systemic illness, 1.67% had cardiogenic shock, 1.67% were cardiac surgery associated and 1.67% had other causes of AKI. 30.0% of cases required ionotropic support while 2.5% of controls required ionotropic support. 5.0% of cases required ventilator support & renal replacement therapy while none of the controls required these.

Conclusions: Patients with AKI had worse outcomes when compared to non-AKI. Mortality among cases was significantly higher than controls, 10% among cases versus only 2.5% in controls.

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References

Aspromonte N, Cruz DN, Ronco C, Valle R. Role of bioimpedance vectorial analysis in cardio-renal syndromes. Semin Nephrol. 2012;32(1):93-9.

Goyal A, Daneshpajouhnejad P, Hashmi MF, Bashir K. Acute Kidney Injury. Treasure Island (FL): Stat Pearls Publishing; 2020.

Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367:2296-304.

Rangaswami J, Bhalla V, John EA, Blair T, Chang I, Costa S, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019;139:e840-78.

Buargub M, Elmokhtar ZO. Incidence and mortality of acute kidney injury in patients with acute coronary syndrome: A retrospective study from a single coronary care unit. Saudi J Kidney Dis Transpl. 2016; 27:752-7.

Mehta RH, Grab JD, O'Brien SM, Bridges CR, Gammie JS, Haan CK, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 2006;114(21):2208-16.

Fliser D, Laville M, Covic A. A European renal best practice (ERBP) position statement on the kidney disease improving global outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant. 2012; 27:4263-72.

Girman CJ, Kou TD, Brodovicz K, Alexander CM, O'Neill EA, Engel S, et al. Acute kidney injury. Diabet Med. 2012;29(5):614-21.

Hsu CY, Ordoñez JD, Chertow GM, Fan D, McCulloch CE, Go AS. Kidney injury. Kidney Int. 2008;74(1):101-7.

Patschan D, Müller GA. Acute kidney injury in diabetes mellitus. Int J Nephrol. 2016;2016:6232909.

Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. Comp Physiol. 2012;2(2):1303-53.

Wang C, Pei YY, Ma YH. Risk factors for acute kidney injury in patients with acute myocardial infarction. Chin Med J. 2019;132(14):1660-5.

Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1: pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol. 2012;60:1031-42.

Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail. 2002;8:136-41.

Smith GL, Vaccarino V, Kosiborod M, Lichtman JH, Cheng S, Watnick SG, et al. Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure?. J Card Fail. 2003;9:13-25.

Newsome BB, Warnock DG, McClellan WM, Herzog CA, Kiefe CI, Eggers PW, et al. Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Arch Intern Med. 2008;68:609-16.

Krumholz HM, Chen YT, Vaccarino V, Wang Y, Radford MJ, Bradford WD, et al. Correlates and impact on outcomes of worsening renal function in patients > or =65 years of age with heart failure. Am J Cardiol. 2000;85:1110-3.

Jiang L, Zhu Y, Luo X. Epidemiology of acute kidney injury in intensive care units in Beijing: the multi-center BAKIT study. BMC Nephrol. 2019;20(1):468.

Kelly KJ. Distant effects of experimental renal ischemia/reperfusion injury. J Am Soc Nephrol. 2003; 14:1549-58.

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Published

2023-07-26

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Original Research Articles