Introduction:
Acute kidney injury (AKI) is a common clinical condition with approximate incidence of 20% in hospitalized patients and is independently associated with in-hospital, morbidity and mortality. Early detection and management of AKI and its complications is needed to decrease its consequences. Hence, studies to investigate the impact of various factors that can alter the course of AKI are always wanting. Magnesium serves as a catalyst for greater than 300 intracellular reactions and plays a role in energy generation, neurotransmitters release, intracellular calcium regulation and protein synthesis and degradation. Hypomagnesemia is associated with non-recovery of renal function after an AKI episode. Calcium homeostasis is commonly disturbed as a consequence of AKI. Ionized calcium is an essential mineral required for many physiologic functions in the body, from cellular function, intracellular messenger transduction, hormonal activity, to cardiac function and neuronal activity. Hypercalcemia causes volume depletion from polyuria and alters intravascular tone leading to AKI. The hepatic influence also contributes to an exaggerated inflammatory response leading to direct liver damage and resultant metabolic derangements, unconjugated bilirubin has an antioxidant and an anti-inflammatory effect. Inflammation and malnutrition influence the prognosis of AKI patients. Serum C reactive protein (CRP), an acute phase protein synthesized by the liver following stimulus by various cytokines, markedly increases within hours after infection or inflammation. ISRNM suggests assessment of albumin, prealbumin and cholesterol in the evaluation of nutritional status.
Methods:
Data from a minimum of 455 patients who are getting admitted in ICU between October2022 to April 2024 was collected. Influence of the serum magnesium, ionized calcium, unconjugated bilirubin, CRP and prealbumin levels was evaluated on the development and outcome of AKI.
Results:
Of the 455 patients, 21.8% were less than 45 years, 34.9% were between 46 to 60 years and 43.3% were above 61years. Most of the AKI cases were seen in the age group above 60 years (54.21%) (p<0.024). Males formed the larger chunk of the study population comprising about 58% and females about 42%. Diabetes mellitus and hypertension were observed in 55.8% and 50.1% respectively. AKI was seen in 57.01% of hypertensives (p<0.103). Out of the 107 patients who developed AKI ,40 patients (37.4%) were dialyzed whereas 67 patients (62.6%) received medical management. In those patients who developed AKI (107). We observed that, highest incidence of AKI was seen in the hypomagnesemia group (< =1.50), i.e., 52.34% compared to those having normal magnesium (47.66%) levels (p <0.001). AKI was more common in hypocalcemic (63.55%) patients when compared to normocalcemic and hypercalcemic (36.45%) patients. Patients with high CRP to prealbumin ratio are more prone for AKI (p <0.001). The number of AKI cases were higher in the group with higher unconjugated bilirubin levels but the p value (0.548) is not significant. It was also observed that the unconjugated bilirubin levels did not significantly alter the outcome of AKI.
Conclusions:
Only hypomagnesemia and higher CRP to Prealbumin ratio were identified as an independent risk factor for incidence of AKI but did not impact the mortality among ICU patients with AKI. Hypocalcemia and unconjugated bilirubin were not identified as an independent risk factor for incidence of AKI and mortality among ICU patients with AKI.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.