Nattachai Srisawat1,2, Win Kulvichit1,2, Noppathorn Mahamitra1, Cameron Hurst3, Kearkiat Praditpornsilpa1, Nuttha Lumlertgul1, Anan Chuasuwan4, Konlawij Trongtrakul5, Adis Tasnarong6, Ratapum Champunot7, Rangsun Bhurayanontachai8, Manasnun Kongwibulwut9, Pornlert Chatkaew9, Petchdee Oranrigsupak10, Theerapon Sukmark11, Thanachai Panaput12, Natthapon Laohacharoenyot13, Karjbundid Surasit14, Thathsalang Keobounma15, Kamol Khositrangsikun16, Ummarit Suwattanasilpa17, Pattharawin Pattharanitima6, Poramin Santithisadeekorn18, Anocha Wanitchanont19, Sadudee Peerapornrattana1,2, Passisd Loaveeravat1, Asada Leelahavanichkul20, Khajohn Tiranathanagul1, Stephen J Kerr21, Kriang Tungsanga1, Somchai Eiam-Ong1, Visith Sitprija1,22, John A Kellum2. 1. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 2. Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 3. Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia. 4. Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand. 5. Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. 6. Department of Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand. 7. Department of Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand. 8. Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Prince Songkla University, Songkla, Thailand. 9. Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 10. Department of Medicine, Nan Hospital, Nan, Thailand. 11. Thungsong Hospital, Nakhon Si Thammarat, Thailand. 12. Kon Kaen Regional Hospital, Kon Kaen, Thailand. 13. Sriphat Medical Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 14. Nakornping Hospital, Chiang Mai, Thailand. 15. Thabo Crown Prince Hospital, Nong Khai, Thailand. 16. Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand. 17. Mahasarakarm Hospital, Mahasarakarm, Thailand. 18. Taksinmaharaj Hospital, Tak, Thailand. 19. Department of Medicine, Cbonburi Hospital, Chonburi, Thailand. 20. Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 21. Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 22. Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand.
Abstract
BACKGROUND: Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand. METHODS: We conducted the largest prospective observational study of AKI in SEA. The data were serially collected on the first 28 days of ICU admission by registration in electronic web-based format. AKI status was defined by full Kidney Disease: Improving Global Outcome criteria. We used AKI occurrence as the clinical outcome and explored the impact of modifiable and non-modifiable risk factors on the development and progression of AKI. RESULTS: We enrolled 5476 patients from 17 ICU centres across Thailand from February 2013 to July 2015. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 2471 of 4668 patients (52.9%). Overall, the maximum AKI stage was Stage 1 in 7.5%, Stage 2 in 16.5% and Stage 3 in 28.9%. In the multivariable adjusted model, we found that older age, female sex, admission to a regional hospital, medical ICU, high body mass index, primary diagnosis of cardiovascular-related disease and infectious disease, higher Acute Physiology and Chronic Health Evaluation II, non-renal Sequential Organ Failure Assessment scores, underlying anemia and use of vasopressors were all independent risk factors for AKI development. CONCLUSIONS: In Thai ICUs, AKI is very common. Identification of risk factors of AKI development will help in the development of a prognostic scoring model for this population and should help in decision making for timely intervention, ultimately leading to better clinical outcomes.
BACKGROUND: Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand. METHODS: We conducted the largest prospective observational study of AKI in SEA. The data were serially collected on the first 28 days of ICU admission by registration in electronic web-based format. AKI status was defined by full Kidney Disease: Improving Global Outcome criteria. We used AKI occurrence as the clinical outcome and explored the impact of modifiable and non-modifiable risk factors on the development and progression of AKI. RESULTS: We enrolled 5476 patients from 17 ICU centres across Thailand from February 2013 to July 2015. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 2471 of 4668 patients (52.9%). Overall, the maximum AKI stage was Stage 1 in 7.5%, Stage 2 in 16.5% and Stage 3 in 28.9%. In the multivariable adjusted model, we found that older age, female sex, admission to a regional hospital, medical ICU, high body mass index, primary diagnosis of cardiovascular-related disease and infectious disease, higher Acute Physiology and Chronic Health Evaluation II, non-renal Sequential Organ Failure Assessment scores, underlying anemia and use of vasopressors were all independent risk factors for AKI development. CONCLUSIONS: In Thai ICUs, AKI is very common. Identification of risk factors of AKI development will help in the development of a prognostic scoring model for this population and should help in decision making for timely intervention, ultimately leading to better clinical outcomes.
Authors: Kathleen D Liu; Stuart L Goldstein; Anitha Vijayan; Chirag R Parikh; Kianoush Kashani; Mark D Okusa; Anupam Agarwal; Jorge Cerdá Journal: Clin J Am Soc Nephrol Date: 2020-04-21 Impact factor: 8.237
Authors: Hossam Abdou; Noha N Elansary; Louisa Darko; Joseph J DuBose; Thomas M Scalea; Jonathan J Morrison; Rishi Kundi Journal: Trauma Surg Acute Care Open Date: 2021-07-15