#3462 A STUDY OF ETIOLOGY OF ACUTE KIDNEY INJURY AND ACUTE ON CHRONIC KIDNEY DISEASE AMONGST IN-HOSPITAL PATIENTS IN A TERTIARY CARE CENTRE IN INDIA
Authors: Das Sayonee , Sengupta Upal , Ganguly Dr Satyabrata 
Published: June 2023

Abstract

Background and Aims
Acute kidney injury (AKI) is the leading cause of nephrology consultation and is associated with high mortality rates. The primary causes of AKI include sepsis, ischemia, hypoxia or nephrotoxicity. An underlying feature is a rapid decline in GFR usually associated with a decrease in renal blood flow. Inflammation represents an important additional component of AKI leading to the extension phase of injury, which may be associated with insensitivity to vasodilator therapy. Recent data suggest that AKI represents a potential link to chronic kidney disease (CKD) in surviving patients. Patients with CKD may be at risk for the development of a transient decrease in renal function consistent with AKI. Such rapidly declining renal function causing an acute deterioration of CKD is termed acute-on-chronic kidney disease (ACKD). The mechanisms by which these occur include failure of auto-regulation, abnormal vasodilatation, susceptibility to antihypertensive agents & side effects of medication. The successful recovery from AKI depends on the degree to which these repair processes ensue & these may be compromised in elderly or CKD patients.

Aim
To determine the burden of AKI among the in-hospital patients & their progression to CKD if at all along with the number & cause of the cases of CKD who develop ACKD due to an acute insult.

Method
The first 100 consecutive patients admitted with Acute Kidney Injury and Acute on Chronic Kidney Disease in the Department of General Medicine, Nephrology, Intensive care unit in KPC Medical College & Hospital, Kolkata, were selected for the study.
Inclusion criteria:
• Patients admitted with AKI, ACKD or developing them during the course of stay.
• CKD stages I to V with acute exacerbation (reduced GFR, reduced urine output).
Exclusion criteria:
• Patients &lt;14 years
• ESRD patients already on hemodialysis.
• Patients with acute Glomerulonephritis (due to the unavailability of biopsy in our institution)
• Patients not giving consent to participate in the study.
For statistical analysis, data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS and GraphPad Prism version 5. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Unpaired proportions were compared by Chi-square test or Fischer's exact test, as appropriate. p-value ≤ 0.05 was considered statistically significant.

Results
● Out of the first 100 consecutive patients fulfilling the study criteria, 33 patients had AKI & 15 patients had ACKD.
● The male population was higher than the female population.
● T2DM and HTN were more common in ACKD patients than the AKI patients.
● Patients with AKI were clinically dehydrated compared to patients with ACKD.
● Metabolic acidosis was less in AKI patients.
● Most of the ACKD patients had sepsis than the AKI patients.

Conclusion
The most common etiology of AKI amongst in-hospital patients is dehydration whereas that of ACKD is sepsis associated with more incidence of metabolic acidosis & comorbidities. Earlier diagnosis of AKI represents an important area in treating patients with AKI that has spawned increased awareness of the potential that biomarkers of AKI may play in the future.