Introduction:
Community-acquired AKI (CA-AKI) is a common clinical condition encountered in a developing country like India. The etiology of CA-AKI is somewhat distinct from that of hospital-acquired AKI, as it is more commonly associated with outpatient factors such as dehydration, infections, and the use of nephrotoxic medications available over the counter. The prognosis of CA-AKI is highly variable, depending on factors such as the etiology, severity of the injury, and the presence of underlying comorbidities. In addition to acute phase of illness, AKI has been increasingly recognized as a risk factor for long-term outcomes, including the progression to CKD and end-stage renal disease (ESRD). Given the potential for severe and long-lasting consequences, early diagnosis, and intervention are crucial in AKI.
Methods:
This hospital-based, prospective observational study was conducted at Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University in Northern India over 12 months (December 2022 to November 2023). The study involved adult patients (>18 years) diagnosed with CA-AKI as per the 2012 KDIGO criteria. The study focused on evaluating clinical, demographic, and laboratory parameters, with patients followed up after discharge to assess renal function recovery at three months for determining the outcome. A comparative analysis was done between recovery and non-recovery using logistic regression analysis.
Results:
The study included 253 patients with CA-AKI, with a mean age of 52.26 ± 17.86 years and 52.6% males. Among the participants, 33.6% reported fever, 24.1% had acute gastroenteritis, and 15.4% experienced dyspnea as an initial presentation. The most common causes of AKI were associated with sepsis (38.3%), Cardiorenal syndrome (11.1%), Obstructive uropathy (10.7%) and Tropical fever (9.5%). The mean hemoglobin level was 11.51 ± 5.42 g/dL and mean neutrophil-to-lymphocyte ratio (NLR) was 4.31 ± 2.36. The mean serum creatinine at baseline was 3.04 ± 2.01 mg/dL, and the mean blood urea nitrogen (BUN) at baseline was 38.57 ± 20.40 mg/d. RRT was required in 5.5%, while 4.7% required vasopressor support. 8.7% patients required an ICU stay and mechanical ventilation was required in 2.8%. The overall recovery, non-recovery and mortality rates were 76.3%, 17.8% and 4.3% respectively. The study identified several factors significantly associated with non-recovery, including advanced age, lower hemoglobin levels, higher baseline serum creatinine and BUN levels (severity of AKI), sepsis, severe symptoms like anasarca and altered sensorium, and the need for advanced care such as RRT, vasopressors, and mechanical ventilation. There was significant association between mortality and factors such as sepsis, hypotension, the need for ICU admission, mechanical ventilation, and vasopressor support. Non-survivors had a higher prevalence of comorbid conditions such as lung disease (27.3%), severe symptoms like altered sensorium (45.5%) and drug-induced AKI (18.2%). Based on these findings, a risk model was developed to predict outcome in CA-AKI.
Conclusions:
The study highlights the critical importance of early intervention and aggressive management in patients with CA-AKI, particularly in those with severe presentations and underlying comorbidities. The findings emphasize the need for improved prognostic models to better predict outcomes and tailor treatment strategies accordingly.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.