UNRAVELING THE DETERMINANTS OF MAJOR ADVERSE KIDNEY EVENTS AFTER ACUTE KIDNEY INJURY IN ADULT PATIENTS

Introduction:

Acute kidney injury (AKI) significantly impact critically ill patients, extending  far beyond the initial insult.Acute kidney injury no more consider as totally reversible condition.The term MAKE(Major adverse kidney events) analoguos to MACE(Major Adverse Cardiac Events) was introduced as consensus composit outcome for Acute kidney injury.The MAKE includes Death,new requirement of dialysis ,progression to AKD and CKD. This study addresses the determinant of MAKE after AKI

Methods:

We include all ICU and ward with AKI as per KDIGO criteria following them from admission through 90 days post discharge. various parameter eg age, sex, charlston comorbidity index, stages of AKI ,cause of AKI , recurrent AKI,underlying chronic kidney disease , mean SOFA and mean APACHE score for predicting the progression to CKD ,dialysis dependency and mortality   after AKI episode. Patient were followed up to 90 days post discharge.data are represented as number,median ,OR(95%CI),we used chi square test for categorical variable and logistic regression model for multivariate analysis to examine the prognostic effects of clinical indicator.

Results:

Of patient,138(43.8%)  completely recovered(creatinine came to baseline within 7 days),39(12.3%) patient had Acute Kidney Disease(AKD),29(9.2%) patient progressed to chronic kidney disease(who has normal baseline creatinine within normal range),88(27.9%) required dialysis ,20(6.3%) being dialysis dependent and 92(29.2%) had mortality. Among the predictors for progression of CKD most important being underlying diabetes OR 1.57(1.23-2.1 95% CI) p value 0.05,stage of  AKI(0R-AKI stage 1-0.33. stage 2-1.07,stage 3-3.03),causes of AKI, sepsis OR-1.33(1.1-1.54 95% CI) p value 0.79 and cardiorenal OR-3.26(2.9-5.44 95% CI) P value 0.08,low EF OR-2.17(1.9-4.4 95%CI) P value 0.02 ,HD requirementOR-5.94(4.8-8.7 95% CI) P value 0.03 recurrent AKI OR-4.04(3.8-6.6 95% CI) P value 0.03 being most common cause ,in multivariate analysis regression model Diabetes HR- 1.15(1-1.33 95% CI)P value ,HD requirement HR-1.28(1.07-1.53 95% CI) P value 0.008,low EF HR-1(0.99-1 95% CI),P value 0.03 predicted the progression to CKD.Among the predictors for mortality stage of AKI OR 2.2(2.16-5.27 95% CI) P value 0.063,cause of AKI as sepsis OR 1.65(0.93-2.93 95%CI), P value 0.0556,negative furosemide stress test OR 4.6(2.05-10.32 95%CI) P value <0.0001,mean APACHE score OR 1.02(1.01,1.028 95% CI) ,P value 0.0037 with multivariate regression model stage of AKI HR 1.059(0.85-1.12 95%CI) P value 0.004 ,underlying chronic kidney disease HR 1.17(1.10-1.24 95% CI),among the cause being cardiorenal HR 1.07(1.008-1.14 95%CI ) P value 0.03 are predictors of mortality.Among the predictors of dialysis dependency stage of AKI OR 7.47(2.41-23.15 95%CI),P value 0.001,negative furosemide stress test OR 7.8(3.42-18.22 95% CI) ,P value <0.0001,mean APACHE score 1.02(1.01-1.025 95% CI) ,P value 0.037,in multivariate regression model cardiorenal as cause of AKI HR 1.07(0.98-1.16 95% CI), P value 0.05,underlying chronic kidney disease HR 1.17(1.04-1.31 95% CI) ,P value 0.003,and recurrence of AKI HR 1.014(0.9-1.08 95% CI) With P value 0.02 predict the dialysis dependency.

Table 1:Baseline characterstics

Table 2: Outcomes

Table 3: Factors for Progression Of CKD 

Table 4: Factors for Dialysis Dependancy

Table 5: Factors to predict mortality

Table 6: Multivariate analysis for CKD progression,dialysis dependency and mortality

Conclusions:

Our study reveals major determinant of MAKE being underlying DM,requirement of dialysis,advanced stage of AKI,cardiovascular dysfunction,recurrent AKI ,and negative furosemide stress test.By identifying  those at greatest risk for MAKE, we open new avenues for targeted interventions and personalized follow-up strategies.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.