Acute kidney injury in surgical patients in an outer-metropolitan hospital

Abstract

Aim To profile the characteristics of patients who have an acute kidney injury (AKI) while admitted to the surgical ward of a secondary level hospital, and to determine how severity of AKI influences patient outcomes.

Background Past research demonstrates that patients with an AKI can be at increased risk of adverse outcomes. Better understanding of this cohort could enable early identification and prevention.

Methods Surgical patients with an AKI were asked to consent for the prospective collection of data from their records. 74 patients over a 20‐month period consented to inclusion. Analysis entailed statistical description.

Results Our data showed that 22% of patients had CKD stage 3 or 4. The majority of patients (57%) had an AKI at the time of their presentation. Of those who had surgery, 60% had an AKI prior to surgery. Urine output was poorly documented in medical records. 89% of the AKI were from pre‐renal causes. KDIGO stage 1 AKI was the most common at 68%. Average length of stay increased with the KDIGO severity (1: 18.9; 2: 21.4; 3: 37.8 days). 15% of patients required ICU, 5% needed dialysis, and 4% died during hospitalisation. At the time of discharge 57% had recovered their renal function.

Conclusions Our data demonstrated that AKI in surgical patients occurred most often pre‐operatively suggesting that their underlying acute surgical condition predisposed them to AKI. Urine output was poorly documented during clinical assessment suggesting that urine output criteria to diagnose AKI is difficult to employ routinely on wards not accustomed to measuring urine output. Patients with more severe AKI had a longer length of stay.