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Open Access Highly Access Research article

Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

Laszlo Medve1, Csaba Antek2, Balazs Paloczi2, Szilvia Kocsi3, Bela Gartner4, Zsuzsanna Marjanek5, Gabor Bencsik6, Peter Kanizsai7 and Tibor Gondos8*

Author Affiliations

1 Department of Anaesthesiology and Intensive Care Medicine, Dr. Kenessey Albert Hospital, Rakoczi ut 125-127, Balassagyarmat, 2660, Hungary

2 Department of Anaesthesiology and Intensive Care Medicine, DEOC, Nagyerdei krt 98, Debrecen, 4032, Hungary

3 Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis ut 6, 6725, Szeged, Hungary

4 Department of Anaesthesiology and Intensive Care Medicine, Petz Aladar County Hospital, Vasvari Pal ut 2-4, 9023, Gyor, Hungary

5 Department of Anaesthesiology and Intensive Care Medicine, Javorszky Odon Hospital, Argenti Dome ter 1-3, Vac, 2600, Hungary

6 Department of Anaesthesiology and Intensive Care Medicine, Hetenyi Geza County Hospital, Toszegi ut 21, Szolnok, 5004, Hungary

7 Department of Anaesthesiology and Intensive Care Medicine, Szent Lukacs Hospital, Korhaz ut 39-41, Dombovar, 7200, Hungary

8 Department of Oxyology and Emergency Care, Semmelweis University, Faculty of Health Sciences, Vas u 17, Budapest, 1088, Hungary

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BMC Nephrology 2011, 12:43 doi:10.1186/1471-2369-12-43

Published: 13 September 2011

Abstract

Background

Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs) in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes.

Methods

We analysed the demographic, morbidity, treatment modality and outcome data of patients (n = 459) admitted to ICUs between October 1st, 2009 and November 30th, 2009 using a prospectively filled in electronic survey form in 7 representative ICUs.

Results

The major reason for ICU admission was surgical in 64.3% of patients and medical in the remaining 35.7%. One-hundred-twelve patients (24.4%) had AKI. By AKIN criteria 11.5% had Stage 1, 5.4% had Stage 2 and 7.4% had Stage 3. In 44.0% of patients, AKI was associated with septic shock. Vasopressor treatment, SAPS II score, serum creatinine on ICU admission and sepsis were the independent risk factors for development of any stage of AKI. Among the Stage 3 patients (34) 50% received renal replacement therapy. The overall utilization of intermittent renal replacement therapy was high (64.8%). The overall in-hospital mortality rate of AKI was 49% (55/112). The ICU mortality rate was 39.3% (44/112). The independent risk factors for ICU mortality were age, mechanical ventilation, SOFA score and AKI Stage 3.

Conclusions

For the first time we have established the incidence of AKI using the AKIN criteria in Hungarian ICUs. Results of the present study confirm that AKI has a high incidence and is associated with high ICU and in-hospital mortality.