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Acute kidney injury and its outcomes in melioidosis

Ravindra Attur Prabhu1, Tushar Shaw2, Indu Ramachandra Rao3

  • 1Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, 576104, Karnataka, India. aravindraprabhu@gmail.com.

Journal of Nephrology
|January 30, 2021
PubMed
Abstract

Insights

Acute kidney injury (AKI) affects over a third of melioidosis patients, increasing mortality risk. Pre-existing chronic kidney disease (CKD) and bacteraemia predict AKI, though kidney function often recovers in survivors.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Critical Care Medicine

Background:

  • Melioidosis, a tropical infection caused by Burkholderia pseudomallei, can affect the kidneys, but this involvement is not well-characterized.
  • Acute kidney injury (AKI) is a significant concern in melioidosis, impacting patient outcomes.

Purpose of the Study:

  • To evaluate the incidence and risk factors of AKI in patients with melioidosis.
  • To determine the outcomes associated with AKI in melioidosis patients, including mortality and intensive care unit (ICU) admission.

Main Methods:

  • A retrospective observational cohort study analyzed data from 164 patients with culture-confirmed melioidosis between 2012 and 2019.
  • Demographics, comorbidities (CKD, diabetes mellitus), and clinical factors (bacteraemia, sepsis, shock, AKI, urinary abnormalities) were assessed.
  • Outcomes including mortality, ICU admission, and hospitalization duration were compared between patients with and without AKI.

Main Results:

  • AKI was observed in 59 (35.98%) of the 164 patients; 13.56% required hemodialysis.
  • Univariate analysis showed AKI was associated with CKD (OR 5.83), bacteraemia (OR 8.82), and shock (OR 3.75).
  • Multivariate analysis identified CKD (aOR 10.68) and bacteraemia (aOR 8.22) as independent predictors of AKI. AKI was linked to higher ICU care needs (37.3% vs. 13.3%) and mortality (32.2% vs. 5.7%).

Conclusions:

  • AKI is a frequent complication of melioidosis, occurring in over a third of cases.
  • Chronic kidney disease and bacteraemia are significant predictors of AKI in melioidosis.
  • While AKI is associated with increased mortality and ICU admission, survivors often experience kidney function recovery.
Keywords:
Acute kidney injuryBacteraemiaBurkholderia pseudomalleiMelioidosisSepsis

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