Clinical Profile and Outcome of Hospital Acquired Acute Kidney Injury versus Community Acquired Acute Kidney Injury- a Prospective Study from Central India

Although the epidemiology and the impact of acute kidney injury on outcomes are well known in the western literature, good data is lacking from central India. Little is known about patients sustaining acute kidney injury (AKI) in the community acquired acute kidney injury (CAAKI) and how this differs from AKI in hospital acquired acute kidney injury (HAAKI). The objective of this study is to compare epidemiology, clinical characteristics, aetiologies, severity and outcomes of patients of these two categories. A prospective study was conducted during 24 months from October 2013 to October 2015 in Sri Aurobindo Medical College and Post Graduate Institute, Indore. All patients admitted to different departments of the hospital and having AKI were included in the study. AKI was verified by applying the RIFLE criteria, and patients were categorized as CAAKI if RIFLE criteria were met at admission. HAAKI was defined as if RIFLE criteria were met twenty four hours or longer after hospitalization. Among the 500 patients with AKI, 286 were classified as CAAKI (57.2%). There was no significant difference in age average and co morbidities between CAAKI and HAAKI. Dehydration and volume depletion were significantly more prevalent in patients with CAAKI (47.9% vs. 28.97% for HAAKI p<0.0001). While HAAKI was associated with a significantly higher prevalence of drug induced AKI (23.36% vs. 7% in CAAKI p<0.0001). Patients with HAAKI were sicker than compared to patients with CAAKI. Maximum RIFLE class was more severe, and mortality rate was higher with class F in both groups. The mortality in hospital was significantly higher in the HAAKI group compared to CAAKI group (51% versus 20% p<0.0001). This study highlights that risk factors for CAAKI and HAAKI are similar, with pre-existing CKD, diabetes, heart disease, hypertension, cancer and tuberculosis being common risk factors for both. As our study had shown, early recognition of AKI that is in RIFLE class I has better outcome in both the groups. So, mortality and morbidity can be safely reduced with team approach and involving nephrologists early in the course of illness.