Epidemiology of Acute Kidney Injury in Moroccan Medical Intensive Care Patients: A Regional Prospective, Observational Study
Science Journal of Public Health
Volume 2, Issue 1, January 2014, Pages: 1-6
Received: Sep. 25, 2013; Published: Nov. 30, 2013
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Rhita Bennis Nechba, Specialist in medical intensive care, Department of critical care. El Idrissi Regional hospital, Kenitra, Morocco; Laboratory of Genetic, Neuroendocrinology and Biothechnology, Ibn Tofaîl University, Kenitra, Morocco
Moncif El M’barki Kadiri, Specialist in nephrology, Department of nephrology, dialysis and transplantation. Military Hospital, Rabat, Morocco
Abdelhalim Mesfioui, Experimental Pharmacology, Laboratory of Genetic, Neuroendocrinology and Biothechnology, Ibn Tofaîl University, Kenitra, Morocco
Amine Ali Zeggwagh, Department of medical intensive care, Ibn Sina University Hospital, Rabat, Morocco and Laboratory of biostatistique, of clinical recherche and epidemiology, Mohammed V university of medicine and pharmacy, Rabat, Morocco
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Objective: To evaluate the incidence, mortality and influencing factors for the development of Acute Kidney Injury (AKI) at admission or during Intensive Care Unit (ICU) stay. Methods: We conducted a prospective, epidemiological survey, in ICU for two years and the data of 97 patients admitted to ICU for medical illness was analyzed. Patients with AKI were categorized by serum creatinine and urine output into 3 stages. Stage 1 was defined as an absolute increase (within 48 hours) in serum creatinine of more than or equal to 0.3 mg/dl, or oliguria of less than 0.5ml/kg per hour for more than six hours. Stage 2 was defined as doubling of serum creatinine, or a urinary output lower than 0.5ml/kg /h for 12 h. Stage 3 was defined as tripling of serum creatinine or a urinary output lower than 0.3 ml/kg/h for 24 h, or anuria for 12 h. Results: Sixty patients ( 62 %) had AKI. AKI patients tended to be older and usually had antecedent of heart disease, a high Simplified Acute Physiology Score version II at admission, more use of mechanical ventilation and vasopressor treatment, more shock, more severe sepsis, more hyperosmolar hyperglycemic state (HHS) and higher mortality. In multivariate analysis, SAPS II score >30, antecedent of heart disease and shock were independent risk factors for development of AKI at admission or during ICU stay. Conclusion: AKI had a high incidence and a high mortality in medical ICU’s patients. Antecedent of severe underlying diseases, heart disease and hemodynamic failure were independent risk factors of AKI.
Acute Kidney Injury, Intensive Care Unit, Mortality, Risk Factors
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Rhita Bennis Nechba, Moncif El M’barki Kadiri, Abdelhalim Mesfioui, Amine Ali Zeggwagh, Epidemiology of Acute Kidney Injury in Moroccan Medical Intensive Care Patients: A Regional Prospective, Observational Study, Science Journal of Public Health. Vol. 2, No. 1, 2014, pp. 1-6. doi: 10.11648/j.sjph.20140201.11
Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR et al. Year in review in Intensive Care Medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals. Intensive Care Med. 2012; 38:192-209.
Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA et al. Spectrum of acute renal failure in the intensive care unit: The PICARD experience. Kidney International 2004 ; 66:1613-21.
Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I et al. Continuous renal replacement therapy: A worldwide practice survey. The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators. Intensive Care Med 2007; 33:1563-70.
Bagshaw SM, George C, Bellomo R: Early acute kidney injury and sepsis: a multicentre evaluation. Critical Care 2008 ; 12:R47.
Medve L, Csaba A, Paloczi B, Kocsi S, Gartner B, Marjanek Z et al. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study. BMC Nephrology 2011; 12:43.
Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med. 2008; 36: S146-51.
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 ; 109:188-91.
Silvester W, Bellomo R, Cole L: Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 2001 ; 29:1910-5.
Vincent JL: Incidence of acute renal failure in the intensive care unit. Contrib Nephrol 2001, 132:1-6.
De Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000; 26:915-21.
Le Gall JR, Lemeshow S, Saulnier F: A new Simplified Acute Physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993 ; 270:2957-63.
Odutayo A, Adhikari NK, Barton J, Burns KE, Friedrich JO, Klein D et al. Epidemiology of acute kidney injury in Canadian critical care units: a prospective cohort study. Can J Anaesth. 2012; 59: 934-42.
Kolhe NV, Stevens PE, Crowe AV, Lipkin GW, Harrison DA: Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2008; 12:S2.
Ostermannw M, Chang R: Riyadh ICU Program Users Group Crit Care. Correlation between the AKI classification and outcome. Critical Care 2008; 12:R144.
Cole L, Bellomo R, Silvester W, Reeves JH: A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a ‘closed’ ICU system. Am J Respir Crit Care Med 2000; 162:191-96.
Coca SG: Acute kidney injury in elderly persons. Am J Kidney Dis 2010; 56:122-31.
Hoste EA, Kellum JA: Incidence, classification, and outcomes of acute kidney injury. Contrib Nephrol 2007 ; 156:32-8.
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.
Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML: Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med 2009 ; 37:2552-8.
Lopes JA, Fernandes P, Jorge S, Goncalves S, Alvarez A, Costa e Silva Z et al. Acute kidney injury in ICU patients: a comparison between RIFLE and AKIN. Critical Care 2008; 12:R110.
Waikar SS, Liu KD, Chertow GM: Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 2008; 3:844-61.
Cruz DN, Ronco C: Acute kidney injury in the intensive care unit: current trends in incidence and outcome. Critical Care 2007 ; 11:149.
Keyes R, Bagshaw SM: Early diagnosis of acute kidney injury in critically ill patients. Expert Rev Mol Diagn 2008; 8:455-64.
Kellum JA, Hoste EA: Acute kidney injury: epidemiology and assessment. Scand J Clin Lab Invest 2008 ; 24: 6-11.
Ricci Z, Cruz D, Ronco C: The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int 2008; 73:538-46.
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.
Himmelfarb J: Acute kidney injury in the elderly: problems and prospects. Semin Nephrol 2009; 29:658-64.
Wen J, Cheng Q, Zhao J, Ma Q, Song T, Liu S et al. Hospital-acquired acute kidney injury in Chinese very elderly persons. J Nephrol.2013; 26:572-9.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006; 34:344-53.
Oppert M, Engel C, Brunkhorst FM, Bogatsch H, Reinhart K, Frei U et al. Acute renal failure in patients with severe sepsis and septic shock a significant independent risk factor for mortality: results from the German Prevalence Study. Nephrol Dial Transplant 2008; 23:904-9.
Zhou Q, Zhao C, Xie D, Xu D, Bin J,Chen P et al. Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes. BMC Nephrology 2012; 13:51.
Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM et al. For the Acute Dialysis Quality Initiative (ADQI) consensus group: Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur Heart J 2010; 31:703-11.
von Haehling Stephan, Storm C, Jörres A, Schefold JC: Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort study. Critical Care 2009; 13:R168.
Marenzi G, Assanelli E, Campodonico J, De Metrio M, Lauri G, Marana I et al. Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission. Crit Care Med 2010; 38:438-44.
Macedo E, Mehta RL: Prerenal failure: from old concepts to new paradigms. Curr Opin Crit Care 2009 ; 15:467-73.
G. Woodrow, A.M. Brownjohn and J.H. Turney. Acute renal failure in patients with type 1 diabetes mellitus.Postgrad Med J.1994; 70:192-4
Izumi T, Shimizu E, Imakiire T, Kikuchi Y, Oshima S, Kubota T et al. A successfully treated case of hyperosmolar hyperglycemic state complicated with rhabdomyolysis, acute kidney injury, and ischemic colitis. Intern Med. 2010; 49:2321-6.
Ka T, Takahashi S, Tsutsumi Z, Moriwaki Y, Yamamoto T, Fukuchi M. Hyperosmolar non-ketotic diabetic syndrome associated with rhabdomyolysis and acute renal failure: a case report and review of literature. Diabetes Nutr Metab. 2003;16: 317-22.
Loghman-Adham M, Kiu Weber CI, Ciorciaro C, Mann J, Meier M. Detection and management of nephrotoxicity during drug development. Expert Opin Drug Saf. 2012; 581-96.
Liangos O. Drugs and AKI. Minerva Urol Nefrol. 2012; 64:51-62.
Vieira JM, Castro I, Curvello-Neto A, Demarzo S, Caruso P, Pastore L et al. Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients. Critical Care Medicine 2007; 35:184-91.
Barrantes F, Feng Y, Ivanov O, Yalamanchili HB, Patel J, Buenafe X et al. Acute kidney injury predicts outcomes of non-critically ill patients. Mayo Clin Proc 2009; 84:410-6.
VA/NIH Acute Renal Failure Trial Network: Intensity of renal support in critically ill patients with acute kidney injury. NEJM 2008 ; 359 Suppl. Appendix.
Daher EF, Silva Junior GB, Santos SQ, Bezerra CC, Diniz EJ, Lima RS et al. Differences in community, hospital and intensive care unit-acquired acute kidney injury: observational study in a nephrology service of a developing country. Clin Nephrol. 2012; 78: 449-55.
Van Berendoncks A, Elseviers MM, Lins RL. Outcome of Acute Kidney Injury with Different Treatment Options: Long-Term Follow-up. Clin J Am Soc Nephrol. 2010; 5: 1755–62.
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