RESUMEN
Acute kidney injury [AKI] is a serious complication in hospitalized patients with a mortality exceeding 50% among those requiring dialysis. The epidemiology and outcome of AKI in critically ill patients in different regions of the world is not well established. The aim of this study was to define the epidemiology, management and outcome of AKI in ICU and non-ICU patients in Kuwait A prospective descriptive epidemiologic single center study was conducted in Al-Sabab Medical Region between January 2003 and December 2005. All cases presented with AM were enrolled in the study. Patients demographic data, Co-morbidities, underlying cause of AKI, and outcome were analyzed using SPSS for windows version 13 [SPSS, inc, Chicago, IL]. Four hundred seventy six patients were identified to have AKI during the study period, 67.02% were males, 254 [53.4%] were Kuwaiti, 168 [35.3%] were Other Arabs and 54 [11.3%] were Non-Arabs. Their mean age was 59.7 +/- 27.25 years, 6.3% were below the age of 30 years. Three hundred ten [65.4%] patients were intensive care unit [ICU] patients. They had the following comorbidities; 55.5% were diabetics, 65.4% had ischemic heart disease, 68.1% had hypertension, 36.4% had chronic kidney disease, 153% had chronic obstructive airway disease, 12.6% had neoplastic diseases, 46.8% had sepsis, 49.4% were hemodynamically unstable, 50% were mechanically ventilated, and 27.3% had multi organ failure. Regarding the active factors precipitating AKI; 20.6% had contrast nephropathy, 11.5% had recent myocardial infarction with cardiogenic shock, 27.1% had septic shock, 13.4% bad drug induced nephotoxidty, 4.8% had obstructive uropathy, 4% had tumor lysis, 9.9% were volume depleted, in 7.5% AKI was multifactorial, 0.6% had rhabdomyolysis, and 0.4% had hepatorenai syndrome. Continuous veno venous hemofiltration [CVVH] was conducted in 47.1% of cases. The overall mortality was 28.4%. Mortality in those treated with CVVH was significantly higher than in those treated conservatively 43.7% versus 14.7% [P<0.001]. However, mortality was higher among ICU patients 38.06% than non-ICU patients 12.6% [P<0.001] AKI is a life threatening condition. The main underlying causes in Kuwait were; septic shock followed by contrast nephropathy after cardiac catheterization. Mortality rate is high with a higher mortality rates among those treated with CVVH The highest mortality rate was detected in ICU patients