FROM INJURY TO CHRONICITY: PREDICTORS OF CHRONIC KIDNEY DISEASE PROGRESSION IN CRITICALLY ILL PATIENTS WITH SEVERE ACUTE KIDNEY INJURY

Acute Kidney Injury (AKI) represents a dynamic clinical condition characterized by an abrupt decline in renal function, which can trigger a cascade of systemic complications and long-term renal impairment. A significant proportion experience incomplete renal repair leading to chronic kidney disease. Early recognition of high-risk patients is crucial for timely interventions to prevent irreversible nephron loss. This study aimed to evaluate the prevalence and determinants associated with AKI progression to CKD in critically ill patients with severe AKI requiring dialysis. after a 3-month follow-up. 

A prospective observational study was conducted among 54 patients in critical care unit diagnosed with severe AKI requiring dialysis of varied etiologies. Institute fully digitalized medical record system allowed seamless data integration and easy follow-up for 3 months. Inclusion criteria: Age ≥18 years diagnosed with Stage 3 AKI according to KDIGO criteria in critical care unit, patients with complete medical records available for baseline and follow-up evaluation. Exclusion criteria: Patients with pre-existing CKD prior to the AKI episode, pregnancy and pediatric patients. Clinical and laboratory parameters were collected and analyzed. Patients were followed up for 3 months, and outcomes were categorized as recovered renal function or progression to CKD based on eGFR values. Statistical analysis included Pearson’s correlation and multiple linear regression to identify predictors of kidney injury progression to chronic non recovering renal failure.

Out of 1300 patients diagnosed to be AKI in Intensive care unit in total of 1year 3 months duration, among them  54 critically ill patients with severe AKI, 40 (74%) were men with a mean age of 54 ± 14 years, 21 patients with hypertension and 22 with diabetic,The mean baseline urea and creatinine were 96 ± 46 mg/dL and 4.0 ± 2.0 mg/dL, respectively, which improved to 62 ± 40 mg/dL and 1.87 ± 1.69 mg/dL after 3 months. Out of 54 patients, 31.5% progressed to CKD, 18.5% succumbed to illness during follow-up, and 9.3% were lost to follow-up despite digital record tracking. Mean CRP was 133.8 ± 99.2 mg/L, with significantly higher levels among patients who developed CKD or expired. CRP showed a moderate positive correlation with TLC (r = 0.412, p = 0.002) and a borderline correlation with baseline urea (r = 0.263, p = 0.054). Multiple regression identified age (p = 0.032), hypertension (p = 0.045), diabetes (p = 0.021), urea (p = 0.012), creatinine (p = 0.001), UPCR (p = 0.038), and CRP elevation (p = 0.009) as significant predictors of progression.

Approximately one-third of critically ill patients with severe AKI progressed to CKD within three months of follow-up, while a notable proportion experienced mortality or were lost to follow-up despite the use of a digital record system. Elevated CRP levels, reflecting systemic inflammation, along with diabetes, hypertension, higher baseline urea and creatinine, and increased proteinuria were significant determinants of poor renal outcomes. Early identification of high-risk patients and structured post-discharge surveillance are essential to reduce both progression to CKD and mortality following severe acute kidney injury