SUMMARY
INTRODUCTION
Acute kidney injury (AKI) is a frequent event among critically ill patients hospitalized in intensive care units (ICU) and represents a global public health problem, being imperative an interdisciplinary approach.
OBJECTIV
To investigate, through literature review, the AKI epidemiology in ICUs. METHODS: Online research in Medline, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences databases, with analysis of the most relevant 47 studies published between 2010 and 2017.
RESULTS
Data of the 67,033 patients from more than 300 ICUs from different regions of the world were analyzed. The overall incidence of AKI ranged from 2.5% to 92.2%, and the mortality from 5% to 80%. The length of ICU stay ranged from five to twenty-one days, and the need for renal replacement therapy from 0.8% to 59.2%. AKI patients had substantially higher mortality rates and longer hospital stays than patients without AKI.
CONCLUSION
AKI incidence presented high variability among the studies. One of the reasons for that were the different criteria used to define the cases. Availability of local resources, renal replacement therapy needs, serum creatinine at ICU admission, volume overload, and sepsis, among others, influence mortality rates in AKI patients.
Acute kidney injury; Intensive care units; Epidemiology; Risk factors
RESUMO
INTRODUÇÃO
Injúria renal aguda (IRA) é um evento frequente entre pacientes criticamente enfermos internados em unidade de terapia intensiva (UTI) e representa um problema de saúde pública global, sendo imperativa uma abordagem interdisciplinar.
OBJETIVO
Investigar, por meio de revisão de literatura, a epidemiologia da IRA em UTIs.
MÉTODOS
Pesquisa on-line nas bases de dados Medline, Scientific Electronic Library Online e Literatura Latino-americana e do Caribe em Ciências da Saúde, com análise dos 47 estudos de maior relevância publicados entre 2010 e 2017.
RESULTADOS
Foram analisados dados de 67.033 pacientes, internados em mais de 300 UTIs de diferentes regiões do mundo. A incidência global de IRA variou de 2,5% a 92,2% e a mortalidade, entre 5% e 80%. O tempo de internação em UTI variou de cinco a 21 dias, enquanto que a necessidade de terapia renal substitutiva, de 0,8% a 59,2%. Pacientes com IRA apresentam índice de mortalidade substancialmente maior e tempo de internação mais elevado, em comparação com pacientes sem IRA. CONCLUSÃO: A incidência de IRA apresentou alta variabilidade entre os estudos e, dentre os motivos, estão os diferentes critérios utilizados para definição dos casos. Disponibilidade de recursos locais, necessidade de terapia renal substitutiva, creatinina na admissão na UTI, sobrecarga volêmica e sepse, dentre outros, influenciam as taxas de mortalidade entre os pacientes com IRA.
Lesão renal aguda; Unidades de terapia intensiva; Epidemiologia; Fatores de risco
INTRODUCTION
Acute kidney injury (AKI) occurs most frequently in critically ill patients admitted to an intensive care unit (ICU) and represents a global public health problem.11. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23.,22. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol. 2015;10(8):1324-31. The implications of AKI go beyond the care context and involve considerable expenditure for health care institutions and systems, as well as contributing to a reduction in patients’ quality of life.33. Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: an increasing global concern. Lancet. 2013;382(9887):170-9.,44. James MT, Tonelli M; Alberta Kidney Disease Network. Financial aspects of renal replacement therapy in acute kidney injury. Semin Dial. 2011;24(2):215-9. In 2014, the International Society of Nephrology launched the “0by25” Project, aiming to reduce avoidable death due to AKI worldwide by promoting universal actions and encouraging scientific dissemination on the subject.55. Mehta RL, Burdmann EA, Cerdá J, Feehally J, Finkelstein F, García-García G, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet. 2016;387(10032):2017-25. Thus, this study aimed to investigate the AKI epidemiology in ICUs.
METHODS
We searched the MEDLINE, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences databases for original articles published in English, Portuguese, and Spanish, with information available about the incidence or mortality of critically ill AKI patients admitted to ICUs. The keywords used in the search were: “acute kidney injury”, “intensive care unit”, and, “epidemiology” with the application of the Boolean operator “AND.” The search occurred between January to February 2018.
RESULTS
Forty-seven studies analyzing data from 67,033 patients from more than 300 ICUs located in different regions of the world were included in this review. The overall incidence of AKI ranged from 2.5%66. Zampieri FG, Ranzani OT, Azevedo LC, Martins ID, Kellum ID, Libório AB. Lactated ringer is associated with reduced mortality and less acute kidney injury in critically ill patients: a retrospective cohort analysis. Crit Care Med. 2016;44(12):2163-70. to 92.2%77. Nascimento MS, Aguiar TC, Silva AVE, Duarte TTP, Magro MCS. Acute kidney injury in the postoperative period of cardiac surgery. Acta Paul Enferm. 2015;28(4):367-73. and mortality from 5%88. Zhao XJ, Zhu FX, Li S, Zhang HB, An YZ. Acute kidney injury is an independent risk factor for myocardial injury after noncardiac surgery in critical patients. J Crit Care. 2017;39:225-31.,99. Thongprayoon C, Cheungpasitporn W, Srivali N, Ungprasert P, Kittanamongkolchai W, Kashani K. The impact of fluid balance on diagnosis, staging, and prediction of mortality in critically ill patients with acute kidney injury. J Nephrol. 2016;29(2):221-7. to 80%, reaching 100% in patients who undergo renal replacement therapy (RRT).1010. Luna LDS, Soares DS, Silva Junior GB, Cavalcante MG, Malveira LRC, Meneses GC, et al. Clinical characteristics, outcomes and risk factors for death among critically ill patients with HIV-related acute kidney injury. Rev Inst Med Trop Sao Paulo. 2016;58:52.
11. Martinuzzi A, Ferraresi E, Orsatti M, Palaoro A, Alcántara S, Corball A, et al. Sepsis e injuria renal aguda en una unidad de cuidados intensivos. Revista Cubana de Alimentación y Nutrición. 2014;24(2 suppl.1):S53-S61.-1212. Peres LA, Wandeur V, Matsuo T. Predictors of acute kidney injury and mortality in an intensive care unit. J Bras Nefrol. 2015;37(1):38-46.
Among the papers included in this review, 28 reflect data from developing countries, 17 from developed nations, and 2 are multinational, including countries with different income categories. The mean AKI incidence in developed and developing countries was 33.4% and 37.7%, while the mean mortality rate was 40.6% and 43.2%, respectively.
The need for RRT was between 0.8%1313. Masewu A, Makulo JR, Lepira F, Amisi EB, Sumaili EK, Bukabau J, et al. Acute kidney injury is a powerful independent predictor of mortality in critically ill patients: a multicenter prospective cohort study from Kinshasa, the Democratic Republic of Congo. BMC Nephrol. 2016;17(1):118.and 59.2%1414. Zhou J, Li Y, Tang Y, Liu F, Yu S, Zhang L, et al. Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis. Nephrology (Carlton). 2015;20(7):485-91. and the ICU, and hospital stay length varied from 5252. Ephraim RKD, Darkwah KO, Sakyi SA, Ephraim M, Antoh EO, Adoba P. Assessment of the RIFLE criteria for the diagnosis of Acute Kidney Injury; a retrospective study in South-Western Ghana. BMC Nephrol. 2016;17(1):99.,1515. Córdoba-Sánchez BM, Herrera-Gómez A, Ñamendys-Silva SA. Acute kidney injury classified by serum creatinine and urine output in critically ill cancer patients. Biomed Res Int. 2016;2016:6805169. to 21 days1616. Hammond DA, Smith MN, Painter JT, Meena NK, Lusardi K. Comparative incidence of acute kidney injury in critically ill patients receiving vancomycin with concomitant piperacillin-tazobactam or cefepime: a retrospective cohort study. Pharmacotherapy. 2016;36(5):463-71. and from 102 to 36 days,1717. Luft J, Boes AA, Lazzari DD, Nascimento ERP, Busana JA, Canever BP. Chronic kidney injury at an intensive care service: clinical characteristics and outcomes. Cogitare Enferm. 2016;21(2):1-9. respectively. Overall, AKI patients showed a risk of mortality almost 50% higher than patients without AKI, and their hospital stay was up to ten days longer (see Table 1).
DISCUSSION
The use of different diagnostic criteria is one of the factors that contributed to the discrepancies observed in the studies in AKI incidence rate.1818. Ricci Z, Ronco C, D’Amico G, De Felice R, Rossi S, Bolgan I, et al. Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrol Dial Transplant. 2006;21(3):690-6.,1919. Selby NM, Fluck RJ, Kolhe NV, Taal MW. International criteria for acute kidney injury: advantages and remaining challenges. Plos Med. 2016;13(9):e1002122. About the geographical location, we verified that AKI-associated mortality rate was higher in developing countries. As demonstrated by another international multicenter study,22. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol. 2015;10(8):1324-31. the risk of death in cases of AKI in ICU is four-fold higher in emerging countries, mainly due to the limited resources available for the adequate/early management of the event.
The AKI occurrence in ICU increases length of stay, need for more vasopressors drugs and specialized human resources, increasing the cost of services and health care systems. The limitation of all these resources and the observed reality in emerging countries contribute to the increase in patients’ morbidity and mortality in regions with lower resources.
Furthermore, the population and the total number of participants included in a study should also be considered. A study reported AKI incidence of 2.5% based on data from approximately 8,000 patients enrolled from the database Multiparameter Intelligent Monitoring in Intensive Care-II.66. Zampieri FG, Ranzani OT, Azevedo LC, Martins ID, Kellum ID, Libório AB. Lactated ringer is associated with reduced mortality and less acute kidney injury in critically ill patients: a retrospective cohort analysis. Crit Care Med. 2016;44(12):2163-70. Whereas, in a study analyzing data from a single-center survey with 51 patients in the postoperative period of cardiac surgery had an incidence higher than 90%.77. Nascimento MS, Aguiar TC, Silva AVE, Duarte TTP, Magro MCS. Acute kidney injury in the postoperative period of cardiac surgery. Acta Paul Enferm. 2015;28(4):367-73.
In two recent multinational, multicenter studies11. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23.,22. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol. 2015;10(8):1324-31. included in this review, the mean incidence of the event was 40.5%, and the mean ICU mortality was 23%, reaching more than 30% among cases that required RRT. In another multinational study published in 2005, AKI incidence in critically ill patients was close to 6%, the need for RRT was higher than 70%, and the mortality predicted in the ICU was 45.6%.2020. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813-8.
These data show that the burden of AKI worldwide is alarming and has been increasing over the past ten years, requiring that the biomedical model of care be replaced by an interdisciplinary health care model, in which actions are planned by a multi-professional health team. In addition, physicians of different specialties (intensivists, nephrologists, and others) should work with a specialized nursing team, pharmacists, physiotherapists, and nutritionists, each bringing their specific professional expertise to integrate quality intensive care.11. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23.
2. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol. 2015;10(8):1324-31.
3. Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: an increasing global concern. Lancet. 2013;382(9887):170-9.-44. James MT, Tonelli M; Alberta Kidney Disease Network. Financial aspects of renal replacement therapy in acute kidney injury. Semin Dial. 2011;24(2):215-9.
The demographic transition that has taken place in developed nations and, more recently in developing countries, has also brought clinical-epidemiological changes in the population profile, expressed by the increase in the life expectancy of individuals. Old age and chronic diseases are among the main AKI risk factors, as they result in systemic and permanent metabolic-physiological alterations that lead to decreased basal organic-functional kidney activity.2121. Anderson S, Eldadah B, Halter JB, Hazzard WR, Himmelfarb J, Horne FM, et al. Acute kidney injury in older adults. J Am Soc Nephrol. 2011;22(1):28-38. However, these changes have also incurred an increase in the burden brought about by chronic-degenerative pathological conditions.2222. Correa-Rotter R, Naicker S, Katz IJ, Agarwal SK, Herrera Valdes R, Kaseje D, et al; ISN-COMGAN Bellagio Study Group 2004. Demographic and epidemiologic transition in the developing world: role of albuminuria in the early diagnosis and prevention of renal and cardiovascular disease. Kidney Int Suppl. 2004(92):S32-7.
Zhou et al.2323. Zhou J, Liu Y, Tang Y, Liu F, Zhang L, Zeng X, et al. A comparison of RIFLE, AKIN, KDIGO, and Cys-C criteria for the definition of acute kidney injury in critically ill patients. Int Urol Nephrol. 2016;48(1):125-32. reported a significant risk for incidence or death from AKI in ICU among individuals over 50 years of age. However, other studies have shown that morbidity and mortality are especially high among individuals older than 60, and the risk increases linearly with age, as well as the chance of needing RRT, which further increases the mortality rate of patients.11. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23.,22. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol. 2015;10(8):1324-31.,1414. Zhou J, Li Y, Tang Y, Liu F, Yu S, Zhang L, et al. Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis. Nephrology (Carlton). 2015;20(7):485-91.,1717. Luft J, Boes AA, Lazzari DD, Nascimento ERP, Busana JA, Canever BP. Chronic kidney injury at an intensive care service: clinical characteristics and outcomes. Cogitare Enferm. 2016;21(2):1-9.,2424. Yokota LG, Sampaio BM, Rocha E, Balbi AL, Ponce D. Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome. Int Nephrol Renovasc Dis. 2017;10:27-33.
Almost all studies listed in Table 1 present diabetes mellitus and systemic arterial hypertension as the chronic diseases that are the most prevalent risk factors in critically ill adults with AKI. Moreover, these are also the chronic conditions that frequently increase morbidity and mortality for AKI in critically ill patients who are septic,1111. Martinuzzi A, Ferraresi E, Orsatti M, Palaoro A, Alcántara S, Corball A, et al. Sepsis e injuria renal aguda en una unidad de cuidados intensivos. Revista Cubana de Alimentación y Nutrición. 2014;24(2 suppl.1):S53-S61.,1616. Hammond DA, Smith MN, Painter JT, Meena NK, Lusardi K. Comparative incidence of acute kidney injury in critically ill patients receiving vancomycin with concomitant piperacillin-tazobactam or cefepime: a retrospective cohort study. Pharmacotherapy. 2016;36(5):463-71.,2525. Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC, et al. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care. 2013;17(6):R278. with fluid overload,22. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol. 2015;10(8):1324-31.,99. Thongprayoon C, Cheungpasitporn W, Srivali N, Ungprasert P, Kittanamongkolchai W, Kashani K. The impact of fluid balance on diagnosis, staging, and prediction of mortality in critically ill patients with acute kidney injury. J Nephrol. 2016;29(2):221-7.,2626. Teixeira C, Garzotto F, Piccini P, Brienza N, Lannuzzi M, Gramaticopolo S, et al; NEFROlogia e Cura INTensiva (NEFROINT) investigators. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care. 2013;17(1):R14. making use of nephrotoxic drugs1616. Hammond DA, Smith MN, Painter JT, Meena NK, Lusardi K. Comparative incidence of acute kidney injury in critically ill patients receiving vancomycin with concomitant piperacillin-tazobactam or cefepime: a retrospective cohort study. Pharmacotherapy. 2016;36(5):463-71. or who have undergone major surgeries.77. Nascimento MS, Aguiar TC, Silva AVE, Duarte TTP, Magro MCS. Acute kidney injury in the postoperative period of cardiac surgery. Acta Paul Enferm. 2015;28(4):367-73.,88. Zhao XJ, Zhu FX, Li S, Zhang HB, An YZ. Acute kidney injury is an independent risk factor for myocardial injury after noncardiac surgery in critical patients. J Crit Care. 2017;39:225-31. Other chronic pathological conditions that are also noted as risk factors for AKI incidence and mortality in critically ill patients include cardiovascular,99. Thongprayoon C, Cheungpasitporn W, Srivali N, Ungprasert P, Kittanamongkolchai W, Kashani K. The impact of fluid balance on diagnosis, staging, and prediction of mortality in critically ill patients with acute kidney injury. J Nephrol. 2016;29(2):221-7.,1717. Luft J, Boes AA, Lazzari DD, Nascimento ERP, Busana JA, Canever BP. Chronic kidney injury at an intensive care service: clinical characteristics and outcomes. Cogitare Enferm. 2016;21(2):1-9.,2727. Czempik P, Ciesla D, Knapik P, Krzych L. Outcomes of patients with acute kidney injury with regard to time of initiation and modality of renal replacement therapy: first data from the Silesian Registry of Intensive Care Units. Kardiochir Torakochirurgia Pol. 2016;13(2):122-9.
28. Danziger J, Chen K, Lee J, Feng M, Mark RG, Celi LA, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med. 2016;44(2):328-34.
29. Herrera-Gutiérrez ME, Seller-Pérez G, Sánchez-Izquierdo-Riera JA, Maynar-Moliner J; COFRADE investigators group. Prevalence of acute kidney injury in intensive care units: the “COrte de prevalencia de disFunción RenAl y DEpuración en críticos” point-prevalence multicenter study. J Crit Care. 2013;28(5):687-94.-3030. Levi TM, Souza SP, Magalhaes JG, Carvalho MS, Cunha AL, Dantas JG, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. 2013;25(4):290-6. respiratory,1010. Luna LDS, Soares DS, Silva Junior GB, Cavalcante MG, Malveira LRC, Meneses GC, et al. Clinical characteristics, outcomes and risk factors for death among critically ill patients with HIV-related acute kidney injury. Rev Inst Med Trop Sao Paulo. 2016;58:52.,3131. Kim MH, Koh SO, Kim EJ, Cho JS, Na SW. Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study. BMC Anesthesiol. 2015;15:23. cerebrovascular,1616. Hammond DA, Smith MN, Painter JT, Meena NK, Lusardi K. Comparative incidence of acute kidney injury in critically ill patients receiving vancomycin with concomitant piperacillin-tazobactam or cefepime: a retrospective cohort study. Pharmacotherapy. 2016;36(5):463-71. cirrhosis,3232. Gaião SM, Gomes AA, Paiva JA. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva. 2016;28(1):70-7.,3333. Singh S, Patra AK, Patel B, Ramesh GS, Sharma VK, Ravishankar V, et al. Acute renal failure in the ICU setting: a prospective observational study. Med J Armed Forces India. 2016;72(3):236-41. cancer1515. Córdoba-Sánchez BM, Herrera-Gómez A, Ñamendys-Silva SA. Acute kidney injury classified by serum creatinine and urine output in critically ill cancer patients. Biomed Res Int. 2016;2016:6805169.,2525. Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC, et al. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care. 2013;17(6):R278., and human immunodeficiency virus infection.1010. Luna LDS, Soares DS, Silva Junior GB, Cavalcante MG, Malveira LRC, Meneses GC, et al. Clinical characteristics, outcomes and risk factors for death among critically ill patients with HIV-related acute kidney injury. Rev Inst Med Trop Sao Paulo. 2016;58:52.,3434. Daher EF, Junior Silva GB, Vieira AP, Souza JB, Falcão FS, Costa CR, et al. Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit. Rev Soc Bras Med Trop. 2014;47(1):86-9.
Several studies have shown baseline renal function as one of the most important risk factors for AKI. Luo et al.3535. Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X, Beijing Acute Kidney Injury Trial (BAKIT) workgroup. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care. 2014;18(4):R144. performed prospective analysis of a database from Beijing (China), with more than three thousand adult patients, and observed that AKI patients identified by KDIGO criteria already had worse baseline renal function in comparison with those without AKI. In this same sense, Yokota et al.2424. Yokota LG, Sampaio BM, Rocha E, Balbi AL, Ponce D. Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome. Int Nephrol Renovasc Dis. 2017;10:27-33. in a prospective study with critically ill elderly patients verified that AKI patients presented worse baseline serum creatinine. Worse baseline renal function also was an AKI risk factor in the study performed by Wang et al.3636. Wang N, Jiang L, Zhu B, Wen Y, Xi XM; Beijing Acute Kidney Injury Trial (BAKIT) Workgroup. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study. Crit Care. 2015;19:371.
In others studies,1212. Peres LA, Wandeur V, Matsuo T. Predictors of acute kidney injury and mortality in an intensive care unit. J Bras Nefrol. 2015;37(1):38-46.,3737. Miralles FM, Ayala RA, Giménez E, Okinaka S. Terapia de reemplazo renal en pacientes de terapia intensiva en el Hospital Central del Instituto de Previsión Social. Nefrología Argentina. 2015;13(2):51-9.
38. Podoll AS, Kozar R, Holcomb JB, Finkel KW. Incidence and outcome of early acute kidney injury in critically-ill trauma patients. PLoS One. 2013;8(10):e77376.-3939. Suarez-de-la-Rica A, Anillo V, Montero A, Hernandez-Gancedo C, Lopez-Tofiño A, Gilsanz F, et al. Risk factors for acute kidney injury in critically ill patients with complicated intra-abdominal infection. J Crit Care. 2017;38:104-8. patients with AKI during ICU stay are the ones with higher serum creatinine at ICU admission, and in the studies performed by Podoll et al.3838. Podoll AS, Kozar R, Holcomb JB, Finkel KW. Incidence and outcome of early acute kidney injury in critically-ill trauma patients. PLoS One. 2013;8(10):e77376. and Peres et al.1212. Peres LA, Wandeur V, Matsuo T. Predictors of acute kidney injury and mortality in an intensive care unit. J Bras Nefrol. 2015;37(1):38-46. it was also associated with a higher risk for mortality.
In the presence of sepsis, the reported incidence of AKI was greater than 70%, and mortality rate reached 80%, higher in patients undergoing RRT,11. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23.,1010. Luna LDS, Soares DS, Silva Junior GB, Cavalcante MG, Malveira LRC, Meneses GC, et al. Clinical characteristics, outcomes and risk factors for death among critically ill patients with HIV-related acute kidney injury. Rev Inst Med Trop Sao Paulo. 2016;58:52.,1111. Martinuzzi A, Ferraresi E, Orsatti M, Palaoro A, Alcántara S, Corball A, et al. Sepsis e injuria renal aguda en una unidad de cuidados intensivos. Revista Cubana de Alimentación y Nutrición. 2014;24(2 suppl.1):S53-S61.,1414. Zhou J, Li Y, Tang Y, Liu F, Yu S, Zhang L, et al. Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis. Nephrology (Carlton). 2015;20(7):485-91.,1717. Luft J, Boes AA, Lazzari DD, Nascimento ERP, Busana JA, Canever BP. Chronic kidney injury at an intensive care service: clinical characteristics and outcomes. Cogitare Enferm. 2016;21(2):1-9.,2424. Yokota LG, Sampaio BM, Rocha E, Balbi AL, Ponce D. Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome. Int Nephrol Renovasc Dis. 2017;10:27-33.,3434. Daher EF, Junior Silva GB, Vieira AP, Souza JB, Falcão FS, Costa CR, et al. Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit. Rev Soc Bras Med Trop. 2014;47(1):86-9.,3636. Wang N, Jiang L, Zhu B, Wen Y, Xi XM; Beijing Acute Kidney Injury Trial (BAKIT) Workgroup. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study. Crit Care. 2015;19:371.,3737. Miralles FM, Ayala RA, Giménez E, Okinaka S. Terapia de reemplazo renal en pacientes de terapia intensiva en el Hospital Central del Instituto de Previsión Social. Nefrología Argentina. 2015;13(2):51-9.,3939. Suarez-de-la-Rica A, Anillo V, Montero A, Hernandez-Gancedo C, Lopez-Tofiño A, Gilsanz F, et al. Risk factors for acute kidney injury in critically ill patients with complicated intra-abdominal infection. J Crit Care. 2017;38:104-8.
40. Herrera-Méndez J, Sánchez-Velázquez LD, González-Chávez A, Rodríguez-Terán G. Incidence of acute renal failure in the intensive care unit at the General Hospital of Mexico: risk factors and associated morbidity and mortality. Rev Med Hosp Gen Méx. 2015;78(2):62-6.
41. Korula S, Balakrishnan S, Sundar S, Paul V, Balagopal A. Acute kidney injury-incidence, prognostic factors, and outcome of patients in an intensive care unit in a tertiary center: a prospective observational study. Indian J Crit Care Med. 2016;20(6):332-6.
42. Kwizera A, Tumukunde J, Ssemogerere L, Ayebale E, Agaba P, Yakubu J, et al. Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an african intensive care unit. Biomed Res Int. 2016;2016:2015251.-4343. Rodríguez MM, Machado VRN, Cedeño JLV. Caracterización clínico-analítica de pacientes con lesión renal aguda en una unidad de cuidados intensivos de adulto, Cienfuegos, 2014. Rev Cub Int Emerg. 2016;15(3):55-69. Sepsis was also an independent factor that increased the length of stay of individuals in ICUs.1111. Martinuzzi A, Ferraresi E, Orsatti M, Palaoro A, Alcántara S, Corball A, et al. Sepsis e injuria renal aguda en una unidad de cuidados intensivos. Revista Cubana de Alimentación y Nutrición. 2014;24(2 suppl.1):S53-S61. The pathophysiological dynamics of the interaction between sepsis and AKI are not fully understood, and the association between sepsis and AKI in ICU patients can cause vascular, glomerular, tubular, and interstitial damage in the kidneys. Nevertheless, it is believed that the inflammatory process, oxidative stress, and apoptosis act as the link of the interaction between the events (see Figure 1). Vasodilation, hypoperfusion, and ischemic injury are probably the primary deleterious effects of this interaction.33. Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: an increasing global concern. Lancet. 2013;382(9887):170-9.,55. Mehta RL, Burdmann EA, Cerdá J, Feehally J, Finkelstein F, García-García G, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet. 2016;387(10032):2017-25.,1111. Martinuzzi A, Ferraresi E, Orsatti M, Palaoro A, Alcántara S, Corball A, et al. Sepsis e injuria renal aguda en una unidad de cuidados intensivos. Revista Cubana de Alimentación y Nutrición. 2014;24(2 suppl.1):S53-S61.,2020. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813-8.
Nephrotoxic agents were an important factor contributing to AKI among critically ill patients4444. Salgado G, Landa M, Masevicius D, Gianassi S, San-Román JE, Silva L, et al. Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study. Med Intensiva. 2014;38(5):271-7.. Two recent studies have shown distinct results on the effect of contrast-induced nephropathy (CIN).3131. Kim MH, Koh SO, Kim EJ, Cho JS, Na SW. Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study. BMC Anesthesiol. 2015;15:23.,4545. Hocine A, Defrance P, Lalmand J, Delcour C, Biston P, Piagnerelli M. Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients. BMC Nephrol. 2016;17:36. Hocine et al.4545. Hocine A, Defrance P, Lalmand J, Delcour C, Biston P, Piagnerelli M. Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients. BMC Nephrol. 2016;17:36. assessed 149 patients in a single-center study in Belgium and Kim et al.3131. Kim MH, Koh SO, Kim EJ, Cho JS, Na SW. Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study. BMC Anesthesiol. 2015;15:23. 335 patients in the Republic of Korea. Although these studies showed a similar incidence of CIN, approximately 15%, CIN patients had a mortality rate 11% higher than those without CIN.4545. Hocine A, Defrance P, Lalmand J, Delcour C, Biston P, Piagnerelli M. Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients. BMC Nephrol. 2016;17:36. In another study, the ICU length of stay of patients with and without CIN was similar, nearly 15 days.3131. Kim MH, Koh SO, Kim EJ, Cho JS, Na SW. Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study. BMC Anesthesiol. 2015;15:23.It should be noted that the pathophysiological genesis of CIN is not yet fully determined; however, the mechanisms may involve renal medullary ischemia and renal tubular damage by toxicity.3131. Kim MH, Koh SO, Kim EJ, Cho JS, Na SW. Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study. BMC Anesthesiol. 2015;15:23.,4545. Hocine A, Defrance P, Lalmand J, Delcour C, Biston P, Piagnerelli M. Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients. BMC Nephrol. 2016;17:36.
Additionally, we verified that fluid overload might represent an independent risk factor for AKI development, need for RRT, and mortality.99. Thongprayoon C, Cheungpasitporn W, Srivali N, Ungprasert P, Kittanamongkolchai W, Kashani K. The impact of fluid balance on diagnosis, staging, and prediction of mortality in critically ill patients with acute kidney injury. J Nephrol. 2016;29(2):221-7.,2626. Teixeira C, Garzotto F, Piccini P, Brienza N, Lannuzzi M, Gramaticopolo S, et al; NEFROlogia e Cura INTensiva (NEFROINT) investigators. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care. 2013;17(1):R14.,3232. Gaião SM, Gomes AA, Paiva JA. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva. 2016;28(1):70-7.,3636. Wang N, Jiang L, Zhu B, Wen Y, Xi XM; Beijing Acute Kidney Injury Trial (BAKIT) Workgroup. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study. Crit Care. 2015;19:371.,4444. Salgado G, Landa M, Masevicius D, Gianassi S, San-Román JE, Silva L, et al. Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study. Med Intensiva. 2014;38(5):271-7. Fluid overload can promote renal interstitial edema and consequent water and saline retention, increased interstitial pressure, reduction of renal blood flow and glomerular filtration rate.2626. Teixeira C, Garzotto F, Piccini P, Brienza N, Lannuzzi M, Gramaticopolo S, et al; NEFROlogia e Cura INTensiva (NEFROINT) investigators. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care. 2013;17(1):R14.,3232. Gaião SM, Gomes AA, Paiva JA. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva. 2016;28(1):70-7. Moreover, fluid overload is also a risk factor for increased intra-abdominal pressure, central venous pressure, and renal venous pressure, which contribute to worsening renal function.2626. Teixeira C, Garzotto F, Piccini P, Brienza N, Lannuzzi M, Gramaticopolo S, et al; NEFROlogia e Cura INTensiva (NEFROINT) investigators. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care. 2013;17(1):R14.,3232. Gaião SM, Gomes AA, Paiva JA. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva. 2016;28(1):70-7.,3636. Wang N, Jiang L, Zhu B, Wen Y, Xi XM; Beijing Acute Kidney Injury Trial (BAKIT) Workgroup. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study. Crit Care. 2015;19:371.
The use of diuretics in critically ill patients is frequent and one of the first strategies to minimize the consequences of fluid overload, but the administration may increase the risk of death in AKI patients.3737. Miralles FM, Ayala RA, Giménez E, Okinaka S. Terapia de reemplazo renal en pacientes de terapia intensiva en el Hospital Central del Instituto de Previsión Social. Nefrología Argentina. 2015;13(2):51-9.,4646. Nisula S, Kaukonen K-M, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, et al; FINNAKI Study Group. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39(3):420-8. In South America, the administration of diuretics was associated with higher mortality of critically ill AKI patients.3737. Miralles FM, Ayala RA, Giménez E, Okinaka S. Terapia de reemplazo renal en pacientes de terapia intensiva en el Hospital Central del Instituto de Previsión Social. Nefrología Argentina. 2015;13(2):51-9. A multicenter Finnish study was identified in which 78.1% of patients who acquired AKI in the ICU were treated with vasoactive drugs.4646. Nisula S, Kaukonen K-M, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, et al; FINNAKI Study Group. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39(3):420-8. In addition, the authors reported that over one-third of the AKI patients that used diuretics had hemodynamic stability or severe sepsis, and the use of diuretics was identified as a risk factor for the increase of AKI incidence.
In the United States, the combined therapy of vancomycin with piperacillin-tazobactam resulted in a higher AKI rate in ICU patients. However, no statistically significant differences were found regarding the need for RRT among patients taking vancomycin combined with cefepime.1616. Hammond DA, Smith MN, Painter JT, Meena NK, Lusardi K. Comparative incidence of acute kidney injury in critically ill patients receiving vancomycin with concomitant piperacillin-tazobactam or cefepime: a retrospective cohort study. Pharmacotherapy. 2016;36(5):463-71.
In a small prospective cohort, Nascimento et al.77. Nascimento MS, Aguiar TC, Silva AVE, Duarte TTP, Magro MCS. Acute kidney injury in the postoperative period of cardiac surgery. Acta Paul Enferm. 2015;28(4):367-73. evaluated 51 patients after bypass surgery and reported AKI incidence of 92.2%. In another study, the AKI occurrence was 5.2%, and the syndrome was an independent risk factor for myocardial injury.88. Zhao XJ, Zhu FX, Li S, Zhang HB, An YZ. Acute kidney injury is an independent risk factor for myocardial injury after noncardiac surgery in critical patients. J Crit Care. 2017;39:225-31.
In addition to cardiac procedures, neurosurgeries, and transplants,11. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23. gastrointestinal, orthopedics, gynecological and urological surgeries4747. Harris DG, McCrone MP, Koo G, Weltz AS, Chiu WC, Scalea TM, et al. Epidemiology and outcomes of acute kidney injury in critically ill surgical patients. J Crit Care. 2015;30(1):102-6. have also been associated with the occurrence of AKI in critically ill patients and are responsible for increasing the risk of death.
The RRT need can significantly increase both the length of hospital stay and patient mortality. In studies performed in Brasil, the mortality in patients undergoing RRT reached 58.4%4848. Valente C, Soares M, Rocha E, Cardoso L, Maccariello E. The evaluation of sequential platelet counts has prognostic value for acute kidney injury patients requiring dialysis in the intensive care setting. Clinics (Sao Paulo). 2013;68(6):803-8. in the Southeast region and 84.2%1212. Peres LA, Wandeur V, Matsuo T. Predictors of acute kidney injury and mortality in an intensive care unit. J Bras Nefrol. 2015;37(1):38-46. in the South region, and the mean length of hospital stay reached 36 days.1717. Luft J, Boes AA, Lazzari DD, Nascimento ERP, Busana JA, Canever BP. Chronic kidney injury at an intensive care service: clinical characteristics and outcomes. Cogitare Enferm. 2016;21(2):1-9. In two studies, the patients’ mortality on continuous RRT modality was around 50%,4343. Rodríguez MM, Machado VRN, Cedeño JLV. Caracterización clínico-analítica de pacientes con lesión renal aguda en una unidad de cuidados intensivos de adulto, Cienfuegos, 2014. Rev Cub Int Emerg. 2016;15(3):55-69.,3232. Gaião SM, Gomes AA, Paiva JA. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva. 2016;28(1):70-7.and in one study, the mortality in RRT by continuous and intermittent modalities reached 74.4%.2727. Czempik P, Ciesla D, Knapik P, Krzych L. Outcomes of patients with acute kidney injury with regard to time of initiation and modality of renal replacement therapy: first data from the Silesian Registry of Intensive Care Units. Kardiochir Torakochirurgia Pol. 2016;13(2):122-9.
There are studies in which the need for mechanical ventilation,22. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol. 2015;10(8):1324-31.,2828. Danziger J, Chen K, Lee J, Feng M, Mark RG, Celi LA, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med. 2016;44(2):328-34.,3333. Singh S, Patra AK, Patel B, Ramesh GS, Sharma VK, Ravishankar V, et al. Acute renal failure in the ICU setting: a prospective observational study. Med J Armed Forces India. 2016;72(3):236-41. as well as elevated central venous pressure3030. Levi TM, Souza SP, Magalhaes JG, Carvalho MS, Cunha AL, Dantas JG, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. 2013;25(4):290-6. and metabolic acidosis2828. Danziger J, Chen K, Lee J, Feng M, Mark RG, Celi LA, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med. 2016;44(2):328-34.,4242. Kwizera A, Tumukunde J, Ssemogerere L, Ayebale E, Agaba P, Yakubu J, et al. Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an african intensive care unit. Biomed Res Int. 2016;2016:2015251.,4545. Hocine A, Defrance P, Lalmand J, Delcour C, Biston P, Piagnerelli M. Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients. BMC Nephrol. 2016;17:36. have proved to be risk factors for AKI and death of patients who already presented the injury. Other risk factors are present in special populations such as patients with infectious diseases,2828. Danziger J, Chen K, Lee J, Feng M, Mark RG, Celi LA, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med. 2016;44(2):328-34. severe acute pancreatitis,1515. Córdoba-Sánchez BM, Herrera-Gómez A, Ñamendys-Silva SA. Acute kidney injury classified by serum creatinine and urine output in critically ill cancer patients. Biomed Res Int. 2016;2016:6805169. overweight/obesity,3232. Gaião SM, Gomes AA, Paiva JA. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva. 2016;28(1):70-7. obstetric complications,4949. Jonard M, Ducloy-Bouthors AS, Boyle E, Aucourt M, Gasan G, Jourdain M, et al. Postpartum acute renal failure: a multicenter study of risk factors in patients admitted to ICU. Ann Intensive Care. 2014;4:36. malaria4242. Kwizera A, Tumukunde J, Ssemogerere L, Ayebale E, Agaba P, Yakubu J, et al. Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an african intensive care unit. Biomed Res Int. 2016;2016:2015251., and trauma victims.3838. Podoll AS, Kozar R, Holcomb JB, Finkel KW. Incidence and outcome of early acute kidney injury in critically-ill trauma patients. PLoS One. 2013;8(10):e77376.
CONCLUSION
AKI incidence presented high variability among the studies, and the different criteria to define the cases is among the reasons. Availability of local resources, renal replacement therapy needs, serum creatinine at ICU admission, volume overload, and sepsis, among others, influence the mortality rates in AKI patients. This literature review demonstrated that a varied combination of risk factors are linked to the increasing incidence and persistence of high mortality rates in the ICU. We believe that knowing the epidemiological aspects of AKI and identifying its main risk factors to achieve early diagnosis are the first steps toward enhancing patient outcomes.
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26Teixeira C, Garzotto F, Piccini P, Brienza N, Lannuzzi M, Gramaticopolo S, et al; NEFROlogia e Cura INTensiva (NEFROINT) investigators. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care. 2013;17(1):R14.
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27Czempik P, Ciesla D, Knapik P, Krzych L. Outcomes of patients with acute kidney injury with regard to time of initiation and modality of renal replacement therapy: first data from the Silesian Registry of Intensive Care Units. Kardiochir Torakochirurgia Pol. 2016;13(2):122-9.
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28Danziger J, Chen K, Lee J, Feng M, Mark RG, Celi LA, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med. 2016;44(2):328-34.
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29Herrera-Gutiérrez ME, Seller-Pérez G, Sánchez-Izquierdo-Riera JA, Maynar-Moliner J; COFRADE investigators group. Prevalence of acute kidney injury in intensive care units: the “COrte de prevalencia de disFunción RenAl y DEpuración en críticos” point-prevalence multicenter study. J Crit Care. 2013;28(5):687-94.
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30Levi TM, Souza SP, Magalhaes JG, Carvalho MS, Cunha AL, Dantas JG, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. 2013;25(4):290-6.
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31Kim MH, Koh SO, Kim EJ, Cho JS, Na SW. Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study. BMC Anesthesiol. 2015;15:23.
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32Gaião SM, Gomes AA, Paiva JA. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva. 2016;28(1):70-7.
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33Singh S, Patra AK, Patel B, Ramesh GS, Sharma VK, Ravishankar V, et al. Acute renal failure in the ICU setting: a prospective observational study. Med J Armed Forces India. 2016;72(3):236-41.
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37Miralles FM, Ayala RA, Giménez E, Okinaka S. Terapia de reemplazo renal en pacientes de terapia intensiva en el Hospital Central del Instituto de Previsión Social. Nefrología Argentina. 2015;13(2):51-9.
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38Podoll AS, Kozar R, Holcomb JB, Finkel KW. Incidence and outcome of early acute kidney injury in critically-ill trauma patients. PLoS One. 2013;8(10):e77376.
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40Herrera-Méndez J, Sánchez-Velázquez LD, González-Chávez A, Rodríguez-Terán G. Incidence of acute renal failure in the intensive care unit at the General Hospital of Mexico: risk factors and associated morbidity and mortality. Rev Med Hosp Gen Méx. 2015;78(2):62-6.
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41Korula S, Balakrishnan S, Sundar S, Paul V, Balagopal A. Acute kidney injury-incidence, prognostic factors, and outcome of patients in an intensive care unit in a tertiary center: a prospective observational study. Indian J Crit Care Med. 2016;20(6):332-6.
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42Kwizera A, Tumukunde J, Ssemogerere L, Ayebale E, Agaba P, Yakubu J, et al. Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an african intensive care unit. Biomed Res Int. 2016;2016:2015251.
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43Rodríguez MM, Machado VRN, Cedeño JLV. Caracterización clínico-analítica de pacientes con lesión renal aguda en una unidad de cuidados intensivos de adulto, Cienfuegos, 2014. Rev Cub Int Emerg. 2016;15(3):55-69.
-
44Salgado G, Landa M, Masevicius D, Gianassi S, San-Román JE, Silva L, et al. Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study. Med Intensiva. 2014;38(5):271-7.
-
45Hocine A, Defrance P, Lalmand J, Delcour C, Biston P, Piagnerelli M. Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients. BMC Nephrol. 2016;17:36.
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46Nisula S, Kaukonen K-M, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, et al; FINNAKI Study Group. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39(3):420-8.
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HighlightsThe incidence of AKI in critically ill patients is worrisome, regardless of geographical location;The value of serum creatinine when the patient is admitted to the ICU can help the early diagnosis of AKI;Sepsis persists with the cause-effect role of AKI, showing a strong association both to the incidence and to the increased mortality of critically ill patients;Requiring RRT continues to have a relationship with worse outcomes;Reducing preventable cases and deaths is a challenge to be faced by all health staffs.
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Funding: There was no funding for this article.
Publication Dates
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Publication in this collection
12 Sept 2019 -
Date of issue
Aug 2019
History
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Received
18 Feb 2019 -
Accepted
13 May 2019