Hospital Practices and Research

Abstract Background: Acute kidney injury appears to be both the cause and the result of developing chronic kidney disease. "Acute on chronic kidney disease" refers to acute kidney injury that develops in the presence of pre-existing chronic kidney disease.
Objectives: This study aimed to gain a better understanding of the disease's incidence and outcomes in a rural area.
Methods: A retrospective analysis was conducted to identify individuals with acute or chronic kidney disease who had acute dialysis at Sakon Nakhon Hospital in Thailand between January 2021 and December 2022. The patient's demographics, clinical symptoms, laboratory values, and outcomes were documented.
Results: There were 82 patients with acute kidney injury requiring dialysis, of which 35 (42.7%) had acute on chronic kidney disease. The mean age was 61.6 ± 13.46 years, with 48.6% being male. Diabetes was the most frequent primary cause and comorbid condition (60%). The majority of indication for acute dialysis (57.1%) was volume overload. Sepsis (37.1%), and urinary tract obstruction (25.7%) were the leading causes of acute renal function decline. There was a significant difference in risk variables between non-survivors and survivors, including shock (P <0.00001), mechanical ventilation use (P = 0.0017), and Intensive Care Unit (ICU) admission (P = 0.0005). Significant mortality-related risk factors identified by logistic regression analysis were shock [OR 159.00, 95%CI 6.86-3683.71; P = 0.002], mechanical ventilation usage [OR 30.79, 95%CI 1.59-597.71; P = 0.024], and ICU admission [OR 43.00, 95%CI 2.18-847.42; P = 0.013].
Conclusion: Acute on chronic kidney disease increased not just in-hospital mortality and morbidity, but also the risk of chronic kidney disease onset and progression.