MP242CAUSES AND OUTCOME OF DIALYSIS-REQUIRING ACUTE KIDNEY INJURY OUTSIDE THE INTENSIVE CARE UNIT

Abstract

Introduction and Aims: Acute kidney injury (AKI) is increasing globally and is associated with severe morbidity and mortality. The aim of the present study was to evaluate the causes and outcome of dialysis-requiring acute kidney injury (AKI-D) treated outside the intensive care unit (ICU). Methods: From January 2010 to August 2015 all patients with AKI-D treated in a single tertiary Nephrology centre were evaluated retrospectively. Results: 128 patients (mean age 69.3±13.7 years, 43% women) were included. 70.3% of AKI-D cases were community-aquired. 75.8% of patients were on diuretics, 57.8% on RAS-blocking agents. Twenty two patients (17.2%) died, 27 patients (21.1%) died or remained with dialysis-dependent chronic renal failure and 101 patients (78.9%) survived with recovered renal function (mean creatinine at discharge: 2.1±1.1 mg/ dL). Patients without renal recovery were significantly older (75.1 vs. 77.9 years, p=0.018), more often suffered from coronary artery disease (CAD) (64 vs. 41.7%, p=0.045) and were more frequently treated with loop diuretics (64 vs. 34%, p=0.006) prior to AKI-D. The causes of AKI-D were categorized into non-hemodynamic (31.3%) and hemodynamic (68.7%). Patients with AKI-D due to hemodynamic causes were older (72.6 vs 62.1 years, p=0.001), were more frequently women (48.9 vs 30%, p=0.046), suffered more often from diabetes (42 vs 22.5%, p=0.033) and CAD (54.5 vs 27.5%, p=0.004), and were more frequently treated with ACE-I or ARB (67 vs 37.5%, p=0.002) and diuretics (75 vs 32.5%, p<0.001). In a multivariate-adjusted logistic regression analysis the risk for AKI-D due to hemodynamic causes increased by 4.5% for each year of higher age, by nearly 200% with pre-existing use of ACE-I or ARB and by 250% by loop diuretics. Conclusions: AKI-D outside the ICU is associated with high morbidity and mortality with one in five patients dying or remaining on dialysis. Strategies to avoid AKI-D should focus on elderly patients treated with RAS-blocking agents and diuretics.