A clinical study on community-acquired acute kidney injury requiring renal replacement therapy and its influencing factors

Objective To investigate the clinical features of community-acquired acute kidney injury (AKI), and analyze the influencing factors of AKI requiring renal replacement therapy. Methods The patients with community-acquired AKI, hospitalized in the Department of Nephrology, The First Affiliated Hospital of USTC from January 2012 to July 2018, were retrospectively enrolled, based on the AKI diagnostic criteria in Kidney Disease:Improving Global Outcomes (KDIGO) Guidelines in 2012. Patients were divided into non-renal replacement therapy group and renal replacement therapy group according to whether renal replacement therapy was performed during hospitalization. The clinical characteristics upon admission and prognosis upon discharge were compared between the two groups. The influencing factors for the requirement for renal replacement therapy were analyzed by Logistic regression. Results (1) A total of 237 community-acquired AKI patients were enrolled, including those with AKI stage 1,2 and 3 accounting for 6.3%, 11.0% and 82.7% respectively. The non-renal replacement therapy group included 127 cases of patients, and the renal replacement therapy group 110 cases of patients. The renal replacement therapy rate was 46.4%. (2) Hypovolemia, infection, history of nephrotoxic drug use, obstructive nephropathy, progression of chronic kidney disease were the main causes of community-acquired AKI. However, 50.2% of patients had two or more risk factors. (3) Multivariate logistic regression analysis showed that AKI stage 3, history of nephrotoxic drug use, and elevated serum potassium, elevated white blood cell count and decreased hemoglobin upon admission were independent risk factors for requirement for renal replacement therapy, while the hypovolemia included in the disease cause was the protective factor which reduced the risk for requiring renal replacement therapy. Conclusions More attention should be paid to the history and etiology of community-acquired AKI patients, especially the use of nephrotoxic drug use and insufficient renal perfusion. Serum potassium, white blood cell count, and hemoglobin upon admission and AKI stages should also be detected, so as to further evaluate whether the patients need renal replacement therapy. Thus, the later treatment plan may be further determined.