Comparison of clinical characteristics of acute kidney injury versus acute-on-chronic renal failure: Our experience in a developing country

Abstract

Background From developing countries, there is paucity of information regarding epidemiological characteristics of acute-on-chronic renal failure (ACRF) that differs from acute kidney injury (AKI). Methods In this prospective study, we analyzed and compared clinical characteristics and outcome of ACRF with AKI from January 2007 to August 2012. Results A total of 1117 patients with community-acquired AKI were included in study (AKI = 835; ACRF = 282). Patients with ACRF were older than patients with AKI (p < 0.001). Sepsis was the main cause of acute decline in renal functions in patients with ACRF in comparison to AKI (p < 0.001). Volume depletion/renal hypoperfusion was the most common cause of AKI and the difference was statistically significant as compared to ACRF (33.9% vs. 17.7%; p < 0.001). Need for dialysis was significantly less in patients with ACRF as compared to AKI (68% vs. 77.4%; p 0.002). Lower inhospital mortality was observed in ACRF in comparison to AKI (5% vs. 8.9%, p = 0.04), while no significant difference was noted in terms of duration of hospital stay between the two groups (p = 0.67). However, a significantly higher proportion of patients with ACRF did not recover and progressed to end-stage renal disease as compared to AKI (20% vs. 7.8%; p < 0.001). Conclusion ACRF constituted an important cause (25%) of AKI. An episode of superimposed AKI is associated with significantly increased risk of progression to end-stage renal disease in patients with chronic kidney disease. Copyright © 2015, Hong Kong Society of Nephrology Ltd. Published by Elsevier Taiwan LLC. All rights reserved.