Burden and Outcomes of Acute Kidney Injury in Critically Ill Patients

Introduction Acute kidney injury (AKI) represents a frequent and serious complication among patients requiring intensive care. This syndrome is a primary driver of elevated morbidity and mortality, while also leading to extended hospital stays and an increased susceptibility to future chronic kidney disease (CKD). Early identification of both risk factors and etiological factors is essential for timely intervention and improved clinical outcomes. The study aimed to evaluate the clinical characteristics, demographic profiles, and etiological risk factors of critically ill patients presenting with AKI and compare the outcomes of patients with and without sepsis. Methods A longitudinal observational study was conducted in the medical and surgical intensive care units (ICUs) of a tertiary care hospital in Kerala between February 2021 and August 2022. A total of 77 adult patients diagnosed with AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria were included in the study. Clinical characteristics, laboratory parameters, etiologies, management strategies, and outcomes were analyzed using IBM SPSS Statistics software, version 25 (IBM Corp., Armonk, NY, USA). A p-value of less than 0.05 was considered statistically significant. Results The overall mortality rate within the enrolled AKI cohort was 21 (27.3%). The majority of the patients were male (50, 64.9%) and over the age of 60 years (35, 45.4%). Community-acquired AKI (CAAKI) constituted 56 (72.7%) of the cases, while hospital-acquired AKI (HAAKI) accounted for 21 (27.2%) cases. Sepsis was identified as the leading cause of AKI at 26 (33.7%), followed by poisoning (13, 16.9%) and cardiac etiologies (14, 18.2%). Mortality was not significantly associated with age, gender, AKI type, or laboratory parameters, including hemoglobin levels or thrombocytopenia. However, mortality was significantly associated with metabolic acidosis (p=0.004), hyperbilirubinemia (p=0.037), and higher KDIGO stages (chi-square (χ²)=6.11, p=0.047). Among the 56 survivors, complete renal recovery was achieved in 47 patients (84.8%), partial recovery was observed in six patients (10.4%), and three patients (5.4%) remained dialysis-dependent at the follow-up period. Conclusion AKI remains a pervasive complication among the critically ill, where it continues to be linked with considerable fatality rates within the intensive care setting. Sepsis is the predominant etiology. Higher KDIGO stages, metabolic acidosis, and hyperbilirubinemia are significant predictors of poor outcomes. Early detection and prompt management of reversible factors may significantly improve survival rates.