Infectious Disease-Related AKI Characterized

Mortality rate is high, especially among patients with HIV/AIDS.
Mortality rate is high, especially among patients with HIV/AIDS.

Brazilian researchers have characterized clinical aspects of acute kidney injury (AKI) associated with infectious diseases in critically patients and identified risk factors for death.

Elizabeth De Fransceco Daher, MD, of the Universidade Federal do Ceará in Fortaleza, Brazil, and colleagues studied 253 patients with AKI admitted to an infectious diseases ICU. Their mean age was 46 years and 72% of patients were male. The most frequent diagnoses were HIV/AIDS (30%), tuberculosis (12%), leptospirosis (11%), and sepsis (11%). Dialysis was required for 70 patients (27.6%).

Using RIFLE criteria, 4.4%, 63.6%, and 32% were classified as “Risk,” “Injury,” and “Failure,” respectively. The mean time from AKI diagnosis to dialysis was 3.6 days. Oliguria was observed in 112 patients (45.7%). Of the 253 patients, 159 died (62.8%). HIV/AIDS patients had a higher mortality rate (76.6%), “most likely due to the severity of immunosuppression and opportunistic diseases,” the researchers reported.

Risk factors for death include use of vasoactive drugs, metabolic acidosis, sepsis, need for mechanical ventilation, hyperkalemia, and hypotension. These factors increased death risk by 6.7, 4.9, 4.3, 3.7, 3.0, and 2.1 times, respectively, the researchers reported in Revista da Sociedade Brasileira de Medicina Tropical (2014;47:86.89).

“Better knowledge of the factors associated with bad prognoses in [AKI] cases is important for improving prevention and treatment, especially among critically ill patients,” the authors concluded.

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