NEW DELHI, Jan 27: Sepsis and tropical fever were found to be the most common causes of community acquired-acute kidney injury (CA-AKI) in India, whereby kidneys fail to filter waste from the blood, according to a new research published in The Lancet Regional Health-Southeast Asia journal.
While sepsis refers to the presence of pus-forming bacteria or their toxins in the blood or tissues, tropical fever is the infection characterised by fever and unique to or prevalent in tropical or subtropical regions.
Conducted across nine tertiary care centres in India, the study also found that the most common comorbidities in these CA-AKI patients included hypertension and diabetes.
The team of scientists, including those from Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, and Madras Medical College, Tamil Nadu, observed that presenting CA-AKI patients to tertiary care units was associated with high mortality.
They also found that a significant number of these patients progressed to developing chronic kidney disease (CKD).
The findings underscored the high mortality risk among patients from most deprived socio-economic groups, the researchers said, urging for immediate attention for targeted interventions. Previous evidence has found CA-AKI to be common in India and other low and middle-income countries (LMICs).
For the study, the team included 3,711 CA-AKI patients older than 12 years and admitted to either the inpatient or emergency departments of the participating hospitals. They defined CA-AKI as “AKI occurring outside the hospital setting – typically in the community or home setting”. AKI recently replaced the term “acute renal failure”.
The researchers constructed the participants’ clinical, demographic, and socioeconomic profiles, along with collecting data regarding their risk factors and causes, comorbidities, complications and patient outcomes.
The team followed up each patient for renal outcomes at discharge and at one and three months after the onset of AKI, with patient outcomes being classified as survivor or non-survivor.
They analysed the data and found that the highest prevalence of AKI was in patients 55-64 years of age, with women being more likely to present with advanced AKI stage 3.
The most common pre-existing comorbidity was found to be hypertension (21.4 per cent), followed by diabetes mellitus (19.1 per cent), chronic liver disease (11.7 per cent), and coronary artery disease (4.2 per cent).
The researchers said that patients with diabetes mellitus and hypertension were more likely to develop stage 3 AKI.
Of the total 3,711 patients, 58.1 per cent lived in rural areas and over one-third consumed alcohol regularly, the researchers found.
Upon performing statistical analyses, the researchers found that older age (over 65 years), alcohol abuse, hypertension, inability to urinate, low platelet count and low socioeconomic status were “significant” predictors of mortality. The mortality risk in patients with AKI was higher in the most deprived group, they said.
“This is the largest registry-based study to report CA-AKI in India. The registry included multiple centers representative of rural and urban populations and major tertiary care centers from north to south and west to eastern parts of India,” the researchers wrote. (PTI)
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