ABSTRACT
Background: Fasting in Ramadan from dawn to sunset is one of Islam's 5 pillars. Islamic lunar calendar is 11 days shorter than Gregorian solar calendar, so the start of Ramadan changes every year and hours spent on fasting vary from 12 hours in Australia, to 21 hours in Sweden, with most countries have 11-16 hours of fasting on average. Patients with certain medical illness are exempted from fasting, however, many such patients partake in fasting. The long hours of fasting may be a risk factor for AKI in certain populations. We assess AKI in Ramadan. Methods: Demographics, comorbidities, treatment, and 4 weeks outcome data for all nephrology consultation for AKI in 4 public hospitals in Kuwait during Ramadan of 2021 (13/April-12/May/2021) prospectively collected and analyzed. We compare AKI in people fasting prior to admission to non-fasting. Results: Total number of AKI cases in Ramadan was 158, 55% males, mean age 64, and 61% were Kuwaiti citizens. Community acquire cases were 15%. DM affected 75%, HTN 72%, and cardiac disease 25% of patients. Median baseline eGFR before AKI was 66.5. Baseline eGFR < 60 seen in 43%, and those compared to patients with eGFR > 60, had median baseline eGFR of 37.5 (vs 92), were older (69 vs 62), 87% had DM (vs 66%) and 87% had HTN (vs 61%). Cause of AKI was pre-renal / ischemic ATN in 69%, COVID-19 related in 17%. Many had more than one possible cause. IV fluids used in 76%, IV diuretics in 39%, IV vasopressors in 31%, and steroids in 21.5%. KRT needed in 27%. Volume overload and electrolytes / acid-base disorders were most common indication (21% and 19% respectively and 15% had more than one indication. Death within 30 days occurred in 11.4%. Of the total, 24% were fasting before admission, with mean age of 56 (compared to 63 for non-fasting). No significant difference in baseline eGFR between fasting and non-fasting, nor in use of IV fluids, IV diuretics, or IV vasopressors. Dialysis needed in 21% of the fasting group, not significantly different from non-fasting group. Mortality rates were lower but not statistically significant in the fasting group (8% vs 12.5%). Conclusions: AKI affect both fasting and non-fasting population similarly, with no increased risk of need for dialysis or mortality.
ABSTRACT
Background: Little is known about AKI epidemiology, causes, management and outcome in Kuwait. We report that. Methods: Demographics, comorbidities, treatment and 4 weeks outcome data for nephrology referrals for AKI in 7 public hospitals from 1/Jan-30/Apr/2021 prospectively collected and analyzed Results: Total number of AKI referrals was 1298, that is 3.3% of hospital admissions. Community acquired cases were 12.5%. Males were 57%, mean age 64 (52% > 65), and Kuwaiti citizens 65%. DM affected 71%, HTN 74%, and cardiac disease 36% of patients. Mean baseline eGFR before AKI was 62. Baseline eGFR < 60 seen in 52%, and those compared to patients with eGFR > 60, had mean baseline eGFR of 35 (vs 90), were older (68 vs 60 with 61% above age 65 vs 41%), 81% had DM (vs 60%), 85% had HTN (vs 63%), 46% had cardiac disease (vs 24%). Cause of AKI was pre-renal / ischemic ATN in 87%, COVID-19 related in 8%, contrast-associated in 6%, drug-induced AIN in 5% of cases. Many had more than one possible cause. Sepsis was most common precipitating factor seen in 67% then volume depletion in 50%. Many had more than one factor. IV fluids used in 73% (less in lower eGFR group), IV diuretics in 46% (more in lower eGFR group), IV vasopressors in 40% (less in lower eGFR group) and steroids in 33%. KRT needed in 33%, more in patients who used diuretics or vasopressors. Volume overload and electrolytes / acid-base disorders were most common indication (75% and 79% respectively). CKRT was modality of choice in 85%, however, in 52% of CKRT, conventional HD not used due to lack of dialysate source in some sites. At 30 days, mean eGFR was 42%, with complete recovery in 34%, and 38% failed to recover at all. Death occurred in 31%, 55% had baseline eGFR > 60, and 50% of deaths occurred while still on KRT. Non-survivors were older and had higher use of vasopressors. AKI associated mortality in 25% of total hospital mortality and in 31% of ICU / CCU mortality. Conclusions: AKI is common. Most cases hospital-acquired. Use of resources (medications, critical care, KRT) and rates of mortality are high. Kuwaiti citizens represent 1/3 of the population and 2/3 of AKI cases and almost 70% of deaths.