A study of clinical profile of patients with community versus hospital acquired acute kidney disease

Samrudhi Bagaria; Animesh Gaur

Volume : VIII, Issue : III, March - 2019

A study of clinical profile of patients with community versus hospital acquired acute kidney disease

Samrudhi Bagaria, Animesh Gaur

Abstract :

Background: Acute kidney injury (AKI) depicts the aupt decline in renal function mostly occuring over the course hours to days. For Acute Dialysis Quality Initiative (ADQI) Modified RIFLE criteria & AKIN criteria were proposed earlier, are now replaced by KDIGO clinical practice guidelines. We aim to evaluate the characteristics and prognosis of hospital acquired AKI (HA–AKI) & community acquired AKI (CA–AKI) patients who were admitted in the hospital for their clinical profile and outcome. Methods: This is a prospective cross sectional hospital based study design on comparison of HA–AKI & CA–AKI patients AKI irrespective of their co–morbities & falling under Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Impaired renal function at the time of admission to the hospital was considered as CA–AKI. AKI developing after 48 h of hospitalization was considered as HA–AKI. RESULTS: Frequency of CA–AKI was significantly higher as compared to HA–AKI. (p<0.001). The Difference in serum creatinine values at admission, after 48 hrs and at 7th day from admission in both, CA–AKI as well as HA–AKI patients was found to be statistically significant (p < 0.001). Highest percentage of patients were in KDIGO stage 3, in both the groups of AKI (50.9% and 61.1% in CA–AKI and HA–AKI respectively. Need for dialysis was higher in patients with HA–AKI (44.4%) as compared to CA–AKI (26.3%). Patients with CA–AKI had significantly higher rate of complete recovery than HA–AKI patients. Higher mortality rates were seem in patients with HA–AKI (38.8%) as compared to CA–AKI (4.9%). Thus, there was significant association between outcome of patients and type of AKI (p<0.001). Conclusion: The frequency of community acquired AKI was much higher as compared to hospital acquired AKI. HA–AKI is common in ICUs, whereas CA–AKI is common in medical wards. Higher mortality was found in HA–AKI than CA–AKI. Patients with CA–AKI have better short and long–term outcomes as compared to HA–AKI. The reason may be the difference in aetiology as most patients of CA–AKI had volume depletion which could be corrected easily.