Acute kidney injury in critically ill surgical patients: epidemiology, risk factors and outcomes

Konlawij Trongtrakul, Chaiwut Sawawiboon, Amanda Y. Wang, Anusang Chitsomkasem, Ploynapas Limphunudom, Sathit Kurathong, Surazee Prommool, Thananda Trakarnvanich, Nattachai Srisawat

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aim: Acute kidney injury (AKI) is one of the most serious complications seen in intensive care units (ICUs). However, its epidemiology, risk factors and clinical outcomes in surgical critically ill patients remains unclear. Methods: A prospective cohort study was conducted in surgical intensive care unit (ICU) of the university hospital in Bangkok, Thailand. AKI was diagnosed according to the KDIGO 2012 criteria. Results: A total of 189 of the 400 patients enrolled in our study developed AKI (47.3%). The severity was: stage 1 = 29.6% of all AKI (56 cases), stage 2 = 30.7% (58 cases), and stage 3 = 39.7% (75 cases). Risk factors of AKI development included a higher BMI, a greater APACHE-II score, septic shock, use of mechanical ventilation, acute medical complications during surgical admission, and pre-existing chronic kidney disease. After adjustment for covariates, only the most severe stage of AKI (stage 3) was associated with increasing 28-day ICU mortality compared with no AKI stage, HR = 7.75 (95% CI, 1.46–41.20, P = 0.02). Conclusion: Acute kidney injury is common and is associated with an increase in mortality in surgical ICU patients. There should be more focus on patients with AKI risk factors to prevent this deleterious event.

LanguageEnglish
Pages39-46
Number of pages8
JournalNephrology
Volume24
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019
Externally publishedYes

Fingerprint

Acute Kidney Injury
Critical Illness
Epidemiology
Intensive Care Units
Critical Care
APACHE
Mortality
Thailand
Septic Shock
Chronic Renal Insufficiency
Artificial Respiration
Cohort Studies
Prospective Studies

Keywords

  • acute renal failure
  • clinical epidemiology
  • critically ill patients
  • surgery

Cite this

Trongtrakul, K., Sawawiboon, C., Wang, A. Y., Chitsomkasem, A., Limphunudom, P., Kurathong, S., ... Srisawat, N. (2019). Acute kidney injury in critically ill surgical patients: epidemiology, risk factors and outcomes. Nephrology, 24(1), 39-46. https://doi.org/10.1111/nep.13192
Trongtrakul, Konlawij ; Sawawiboon, Chaiwut ; Wang, Amanda Y. ; Chitsomkasem, Anusang ; Limphunudom, Ploynapas ; Kurathong, Sathit ; Prommool, Surazee ; Trakarnvanich, Thananda ; Srisawat, Nattachai. / Acute kidney injury in critically ill surgical patients : epidemiology, risk factors and outcomes. In: Nephrology. 2019 ; Vol. 24, No. 1. pp. 39-46.
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abstract = "Aim: Acute kidney injury (AKI) is one of the most serious complications seen in intensive care units (ICUs). However, its epidemiology, risk factors and clinical outcomes in surgical critically ill patients remains unclear. Methods: A prospective cohort study was conducted in surgical intensive care unit (ICU) of the university hospital in Bangkok, Thailand. AKI was diagnosed according to the KDIGO 2012 criteria. Results: A total of 189 of the 400 patients enrolled in our study developed AKI (47.3{\%}). The severity was: stage 1 = 29.6{\%} of all AKI (56 cases), stage 2 = 30.7{\%} (58 cases), and stage 3 = 39.7{\%} (75 cases). Risk factors of AKI development included a higher BMI, a greater APACHE-II score, septic shock, use of mechanical ventilation, acute medical complications during surgical admission, and pre-existing chronic kidney disease. After adjustment for covariates, only the most severe stage of AKI (stage 3) was associated with increasing 28-day ICU mortality compared with no AKI stage, HR = 7.75 (95{\%} CI, 1.46–41.20, P = 0.02). Conclusion: Acute kidney injury is common and is associated with an increase in mortality in surgical ICU patients. There should be more focus on patients with AKI risk factors to prevent this deleterious event.",
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Trongtrakul, K, Sawawiboon, C, Wang, AY, Chitsomkasem, A, Limphunudom, P, Kurathong, S, Prommool, S, Trakarnvanich, T & Srisawat, N 2019, 'Acute kidney injury in critically ill surgical patients: epidemiology, risk factors and outcomes', Nephrology, vol. 24, no. 1, pp. 39-46. https://doi.org/10.1111/nep.13192

Acute kidney injury in critically ill surgical patients : epidemiology, risk factors and outcomes. / Trongtrakul, Konlawij; Sawawiboon, Chaiwut; Wang, Amanda Y.; Chitsomkasem, Anusang; Limphunudom, Ploynapas; Kurathong, Sathit; Prommool, Surazee; Trakarnvanich, Thananda; Srisawat, Nattachai.

In: Nephrology, Vol. 24, No. 1, 01.01.2019, p. 39-46.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Acute kidney injury in critically ill surgical patients

T2 - Nephrology

AU - Trongtrakul, Konlawij

AU - Sawawiboon, Chaiwut

AU - Wang, Amanda Y.

AU - Chitsomkasem, Anusang

AU - Limphunudom, Ploynapas

AU - Kurathong, Sathit

AU - Prommool, Surazee

AU - Trakarnvanich, Thananda

AU - Srisawat, Nattachai

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aim: Acute kidney injury (AKI) is one of the most serious complications seen in intensive care units (ICUs). However, its epidemiology, risk factors and clinical outcomes in surgical critically ill patients remains unclear. Methods: A prospective cohort study was conducted in surgical intensive care unit (ICU) of the university hospital in Bangkok, Thailand. AKI was diagnosed according to the KDIGO 2012 criteria. Results: A total of 189 of the 400 patients enrolled in our study developed AKI (47.3%). The severity was: stage 1 = 29.6% of all AKI (56 cases), stage 2 = 30.7% (58 cases), and stage 3 = 39.7% (75 cases). Risk factors of AKI development included a higher BMI, a greater APACHE-II score, septic shock, use of mechanical ventilation, acute medical complications during surgical admission, and pre-existing chronic kidney disease. After adjustment for covariates, only the most severe stage of AKI (stage 3) was associated with increasing 28-day ICU mortality compared with no AKI stage, HR = 7.75 (95% CI, 1.46–41.20, P = 0.02). Conclusion: Acute kidney injury is common and is associated with an increase in mortality in surgical ICU patients. There should be more focus on patients with AKI risk factors to prevent this deleterious event.

AB - Aim: Acute kidney injury (AKI) is one of the most serious complications seen in intensive care units (ICUs). However, its epidemiology, risk factors and clinical outcomes in surgical critically ill patients remains unclear. Methods: A prospective cohort study was conducted in surgical intensive care unit (ICU) of the university hospital in Bangkok, Thailand. AKI was diagnosed according to the KDIGO 2012 criteria. Results: A total of 189 of the 400 patients enrolled in our study developed AKI (47.3%). The severity was: stage 1 = 29.6% of all AKI (56 cases), stage 2 = 30.7% (58 cases), and stage 3 = 39.7% (75 cases). Risk factors of AKI development included a higher BMI, a greater APACHE-II score, septic shock, use of mechanical ventilation, acute medical complications during surgical admission, and pre-existing chronic kidney disease. After adjustment for covariates, only the most severe stage of AKI (stage 3) was associated with increasing 28-day ICU mortality compared with no AKI stage, HR = 7.75 (95% CI, 1.46–41.20, P = 0.02). Conclusion: Acute kidney injury is common and is associated with an increase in mortality in surgical ICU patients. There should be more focus on patients with AKI risk factors to prevent this deleterious event.

KW - acute renal failure

KW - clinical epidemiology

KW - critically ill patients

KW - surgery

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U2 - 10.1111/nep.13192

DO - 10.1111/nep.13192

M3 - Article

VL - 24

SP - 39

EP - 46

JO - Nephrology

JF - Nephrology

SN - 1320-5358

IS - 1

ER -

Trongtrakul K, Sawawiboon C, Wang AY, Chitsomkasem A, Limphunudom P, Kurathong S et al. Acute kidney injury in critically ill surgical patients: epidemiology, risk factors and outcomes. Nephrology. 2019 Jan 1;24(1):39-46. https://doi.org/10.1111/nep.13192