ePidEmiology, Risk FactORs, and outcoMes of AKI (PERFORM-AKI)
Ying Wang, Johnathan Ngo, Praveen Sheral Perera, Kathryn Higgins, Natashja Eyles, Zoltan Huba Endre, Shaundeep Sen, Muh Geot Wong, Lucinda Alix Wynter, John Paul Killen, Séverine Bompoint, Rinaldo Bellomo, Martin Gallagher · Journal of the American Society of Nephrology · 2024
Background: Acute kidney injury (AKI) is common in hospitalised patients and associated with significant morbidity and mortality. Many AKI studies focus upon Intensive Care Unit (ICU) patients, while literature on non-ICU patients with AKI is often limited by retrospectively defined cohorts with varying definitions. The PERFORM-AKI study aims to assess epidemiological and clinical characteristics of hospitalised non-ICU patients with AKI. Methods: PERFORM-AKI is a multicentre prospective cohort study across 5 centres in Australia. The KDIGO criteria for AKI were used for diagnosing and staging. Baseline data at initial renal consult and follow up data at day 14 or at discharge (whichever occurred first) were collected. Partial renal recovery was defined as the serum creatinine level at the time of follow up has returned to within 50% of baseline levels. Results: The study included 639 hospitalised patients with AKI diagnosed outside ICU from February 2021 to October 2023. The mean age was 75 years (SD 14.6 years) with a male predominance (57%). The top three pre-existing comorbidities were hypertension (77.3%), cardiovascular disease (58.1%) and diabetes (43.7%). The most common causes of AKI were hypovolaemia (57.0%), sepsis (43.0%) and drug-induced nephrotoxicity (26.6%). Treatments used for AKI were intravenous fluids (57.6%), cessation of nephrotoxic agents (47.3%), and administration of antibiotics (37.2%). There was no significant difference in diagnosis and management of AKI between the initial and follow up renal consultation. AKI was graded as stage 1 in 51.1%, stage 2 in 25.1% and stage 3 in 23.8 % of patients. Mortality across the cohort was 5.6%, few patients (1.7%) required renal replacement therapy, and 75 patients (11.8%) met the definition for partial renal recovery. Conclusion: Epidemiology and outcomes of AKI in non-ICU patients are distinct to their ICU requiring counterparts. Hypovolaemia is the most common cause of AKI in this cohort, and most patients had incomplete renal recovery by day 14. Since persistent AKI is associated with higher mortality, this study suggests early nephrology follow-up should be encouraged or even mandated in these patients. Funding: Private Foundation Support