Speakers - WNSC 2024

Abstract

Early identification of acute kidney injury (AKI) and acute kidney disease (AKD) has been the therapeutic target in intensive care since critical interventions must be initiated in order to preserve a functional reserve and thus alter the natural history of kidney disease and prevent the establishment of chronic kidney disease. The objective of this study was to verify the incidence and identify factors associated with acute kidney disease in critically ill patients. Methods: Prospective quantitative cohort study carried out in an Intensive Care Unit (ICU) with follow-up of 141 patients. AKI was identified by Kidney Disease: Improving Global Outcomes (KDIGO). AKD was identified when the increase in creatinine was sustained for a period equal to or greater than 7 days up to 90 days after exposure to an initial AKI event. To evaluate the recovery of renal function, the calculation of the ratio of serum creatinine (sCr) in relation to the basal sCr was adopted, which were then classified as: (1) Total recovery of renal function: creatinine returns to the basal sCr value; (2) Did not recover: sCr remains at a value above 1.5x in relation to baseline. The Chisquare and Fisher's exact tests were used to verify associations between variables, considering p values <0.001 to be significant. Results: AKI was identified in 41.85% of patients and of these, 20% progressed to AKD. Those with AKI were older [61 (51 – 65) years vs 57 (46 – 68) years, p=0.742], and remained in the ICU longer [14.0 (12.0 - 15.0) days vs 7,0 (5.0 - 13.0) days, p=0.01]. Of the patients with AKD, 75% had greater renal impairment, represented by the KDIGO 3 classification (p=0.005) and only 15% managed to recover renal function (p=0.002), showing a reduction in functional reserve over time. Conclusion: Critically ill patients with AKI were older, with prolonged ICU stay, evolving with lower functional reserve given the reduced recovery of renal function and greater renal impairment (KDIGO 3)