Acute Kidney Injury in Severe Trauma Patients; a Record-Based Retrospective Study
Introduction: Acute kidney injury (AKI) is a common and devastating clinical issue in the community associated with high rates of morbidity and mortality. Objective: We aimed at estimating the frequency and levels of severity of AKI in trauma patients requiring hospital admission using the RIFLE criteria and assess their outcome. Method: Our retrospective record based study enrolled data of 80 participants aged 18-59 years who presented to the emergency department of KIMS hospital following an acute traumatic event. Participants with pre-existing renal dysfunction, chronic heart failure and chronic liver disease were excluded. Tests of significance were Chi square and independent sample t test, a p<0.05 was considered statistically significant. Results: Participants with AKI had significantly lower age (p=0.02) and lower revised trauma score (RTS) (p=0.01). Significant association of AKI with hypotension (p=0.01) and Glasgow coma scale (GCS) (p=0.008) was observed. No association of AKI with gender was observed (p=0.6). None of the AKI patients required renal replacement therapy and all participants attained normal renal function at discharge. Significantly longer mean duration of hospital stay (14.4 days) was observed among AKI patients (p=0.02). Totally, 6.3 % mortality was observed among both participants with and without AKI. Conclusion: Forty percent of acute trauma patients had AKI (in risk and injury category); but none were in failure, loss or end stage renal disease. No association of AKI and mortality was observed. AKI was associated with age, RTS, hypotension and GCS.
2. Makris K, Spanou L. Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. Clin Biochem Rev. 2016;37(2):85–98.
3. Harty J. Prevention and Management of Acute Kidney Injury. Ulster Med J. 2014;83(3):149–57.
4. Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66(4):1613–21.
5. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–8.
6. Gurjar M, Baronia AK, Azim A, Prasad N, Jain S, Singh RK, et al. Septic acute kidney injury in critically ill Indian patients. Indian J Crit Care Med. 2013;17(1):49–52.
7. Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract. 2013;2013:479730.
8. Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, et al. An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: an international consensus conference in intensive care medicine. Am J Respir Crit Care Med. 2010;181(10):1128–55.
9. Waikar SS, Betensky RA, Emerson SC, Bonventre JV. Imperfect gold standards for kidney injury biomarker evaluation. J Am Soc Nephrol. 2012;23(1):13–21.
10. Jenq C-C, Tsai M-H, Tian Y-C, Lin C-Y, Yang C, Liu N-J, et al. RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients. Intensive Care Med. 2007;33(11):1921–30.
11. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73.
12. Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling C-R. Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria. Nephrol Dial Transplant. 2005;20(2):354–60.
13. Colpaert K, Hoste EA. Acute kidney injury in burns: a story of volume and inflammation. Crit Care. 2008;12(6):192.
14. Bagshaw SM, George C, Gibney RTN, Bellomo R. A multi-center evaluation of early acute kidney injury in critically ill trauma patients. Ren Fail. 2008;30(6):581–9.
15. Sloan EP, Koenigsberg M, Clark JM, Desai A. The use of the Revised Trauma Score as an entry criterion in traumatic hemorrhagic shock studies: data from the DCLHb clinical trials. Prehosp Disaster Med. 2012;27(4):330–44.
16. El Sayad M, Noureddine H. Recent Advances of Hemorrhage Management in Severe Trauma. Emerg Med Int. 2014;2014:638956.
17. Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J. 2013;6(1):8–14.
18. Breslau N. Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med. 2002;5(1):34–40.
19. Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959–92.
20. Yasan A, Saka G, Ozkan M, Ertem M. Trauma type, gender, and risk of PTSD in a region within an area of conflict. J Trauma Stress. 2009;22(6):663–6.
21. Das A, Gjerde H, Gopalan SS, Normann PT. Alcohol, drugs, and road traffic crashes in India: a systematic review. Traffic Inj Prev. 2012;13(6):544–53.
22. Harrois A, Libert N, Duranteau J. Acute kidney injury in trauma patients. Curr Opin Crit Care. 2017;23(6):447–56.
23. Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R. Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med. 2008;36(2):610–7.
24. Lakshminarayana GR, Sheetal LG, Mathew A, Rajesh R, Kurian G, Unni VN. Hemodialysis outcomes and practice patterns in end-stage renal disease: Experience from a Tertiary Care Hospital in Kerala. Indian J Nephrol. 2017;27(1):51–7.
25. Hodeify R, Megyesi J, Tarcsafalvi A, Mustafa HI, Hti Lar Seng NS, Price PM. Gender differences control the susceptibility to ER stress-induced acute kidney injury. Am J Physiol Renal Physiol. 2013;304(7):F875–82.
26. Liu ZZ, Mathia S, Pahlitzsch T, Wennysia IC, Persson PB, Lai EY, et al. Myoglobin facilitates angiotensin II-induced constriction of renal afferent arterioles. Am J Physiol Renal Physiol. 2017;312(5):F908–16.
27. Zorova LD, Pevzner IB, Chupyrkina AA, Zorov SD, Silachev DN, Plotnikov EY, et al. The role of myoglobin degradation in nephrotoxicity after rhabdomyolysis. Chem Biol Interact. 2016;256:64–70.
28. Moore EM, Bellomo R, Nichol A, Harley N, Macisaac C, Cooper DJ. The incidence of acute kidney injury in patients with traumatic brain injury. Ren Fail. 2010;32(9):1060–5.
29. Palevsky PM. Renal Replacement Therapy in AKI. Adv Chronic Kidney Dis. 2013;20(1):76–84.
30. Conger JD. Does Hemodialysis Delay Recovery from Acute Renal Failure? Seminars in Dialysis. 1990;3(3):146–8.
31. Palevsky PM, Baldwin I, Davenport A, Goldstein S, Paganini E. Renal replacement therapy and the kidney: minimizing the impact of renal replacement therapy on recovery of acute renal failure. Curr Opin Crit Care. 2005;11(6):548–54.
32. Mehta S, Chauhan K, Patel A, Patel S, Pinotti R, Nadkarni GN, et al. The prognostic importance of duration of AKI: a systematic review and meta-analysis. BMC Nephrol. 2018;19:91