AKI in kuwait: Incidence, causes, management, and outcomes-a prospective observational study

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.