Risk factors for community-acquired acute kidney injury and impact of its initial management on short-term outcome

Abstract

Background Acute kidney injury (AKI) is a major health problem with poor short- and long-term outcomes. Community-acquired AKI (CA-AKI) occurs if the patient developed an increase in serum creatinine at the time of admission and that increase has developed outside the hospital. Infections, such as gastroenteritis, pneumonia, skin and soft tissue infections, acute glomerular diseases, obstetric complications, and herbal remedies are common etiologies. Patients and methods This is a single-center prospective observational study where we evaluated the clinical characteristics, risk factors, associated comorbidities, and outcomes of CA-AKI in patients admitted to a Hospital over a 12-week period. Results We identified 212 patients with CA-AKI, which represented 1.86% of patients admitted to a hospital during the study period, of which 121 (57.1%) were female, with a mean age of 59.69 ± 14.49 years. Hypertension, diabetes, and chronic kidney disease were the most common associated comorbidities. Renal causes were the most common cause of AKI in 146 patients, prerenal in 93 patients and postrenal in 50 patients. The primary outcome was in-hospital mortality, which occurred in a third (33%) of the afflicted patients, while renal recovery occurred in the majority of CA-AKI cases with variable rates of partial and complete recovery. Follow-up of renal functions after 3 months of discharge revealed stable serum creatinine in 66 (50%) patients, 23 (17.4%) patients showed further improvement in serum creatinine (lower serum creatinine than its value upon discharge) and nine (6.8%) patients deteriorated further. Conclusions Hypertension, diabetes, and chronic kidney disease were the most common associated comorbidities with CA-AKI. Sepsis-associated AKI and hypovolemia were the most common etiologies. While most CA-AKI episodes resulted in renal recovery, around one-third of the affected patients died.