- Email: [email protected]
037 THE EFECTS OF TIMING AND AKI STAGES IN OUTCOMES: A SINGLE CENTRE PROSPECTIVE COHORT STUDY
1ST ASIA PACIFIC AKI CRRT 2017 and death were evaluated. The AKIN classification was used to define acute injury. Results: We identified 555 patients admitted to clinical and surgical wards, corresponding to 1,49% of the total number of patients hospitalized in the period, who was submited into hemodialyses and classified as having acute renal failure (lower incidence than that found in the literature - 3.8%), of which 47,9% women and 52,1% men, with a mean age of 75,7 years. The double lumen catheter was the only type of vascular access used; peritoneal dialysis wasn’t indicated for these patients. Systemic arterial hypertension was the main comorbidity presented, affecting 45% of the patients, followed by diabetes (27.8% of the cases). The causes of acute renal injury were: - septic (pneumonia 40%) responsible for 52%, cardiogenic shock 16%, major surgeries 15% and drug induced nephropathy 12%. There was recovery of renal function in 13.3% (lower than that found in the literature) with a 45,05% evolution for outpatient dialysis and the mortality rate was 41,80%. The mortality found was compatible with the data present in the literature, being a clinical entity with a high mortality rate. Conclusion: Despite the medical advances of recent years, acute dialysis renal failure, is a pathological entity with a high degree of mortality. Septic conditions, especially pneumonia, contribute to mortality and are among the main causes of renal impairment in patients with acute renal failure.
035 EPIDEMIOLOGY, RISK FACTORS AND SURVIVAL OF AKI PATIENTS TREATED BY CRRT - A STUDY FROM RURAL INDIA Sampathkumar, Krishnaswamy, Rajiv, Andrew, Nayak, Aditya, Saravanan, Ratchagan, Kumar, Shakthi, Anandan Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai- 625107, India
Category: Epidemiology and Outcomes from AKI Presenter: Prof KRISHNASWAMY SAMPATHKUMAR Keywords: CRRT, AKI, ICU, Shock, APACHE. Introduction: AKI encountered in ICU is accompanied by shock which
precludes Intermittent Hemodialysis. CRRT is not commonly offered to such patients in many ICUs of India. Objective: A retrospective cohort study of patients with AKI was undertaken in our renal centre which caters to rural population of South India to analyse the epidemiology and survival of patients treated with CRRT. Methodology: Consecutive patients who were treated with CRRT from January 2015 to October 2016 formed the Study Group.The mode of CRRT was uniformly CVVHDF [Prismaflex - Baxter] in all patients with target Effluent volume of 20 ml/Kg/hr with pre filter infusion of commercially available [Prismasol] replacement fluid. APACHE II score was calculated at the point of start of CRRT initiation. Survivors and Non survivors were compared using various clinical and biochemical risk factors. Student’s t-test for quantitative variables and Chi-square (Ïz2) test for qualitative variables were used for comparison. A P < 0.05 was considered statistically significant. Primary outcome was In hospital Survival. Results: 127 patients who developed AKI were offered CRRT out of 1544 patients admitted in ICU [8.2 %]. 12 [9%] of these patients could not afford CRRT. 115 patients were treated with CRRT and formed the study group. Mean age was 50 8 years. 66% were males. Community acquired AKI [89%] was more common than hospital acquired AKI [11%]. Medical [63%] Surgical [28%] and Obstetric [7.8%] AKI were seen. Medical causes included Septic shock [58%], cardiogenic shock [20%], Hepatorenal syndrome [9.5%] and Pancreatitis [7.8%]. Emphysematous Pyelonephritis [8], scrub typhus [2], and Dengue shock syndrome [2] were encountered. Vascular access was mainly via Femoral vein [94%.], CRRT was heparin free in 53% of sessions. 78% required ventilatory support. In hospital survival was 42%. It was predicted by higher Mean BP [ 72 mm Hg vs 62 mm Hg (p <001)], Lower APACHE II score [24 vs 29 (p ¼ < 0.001)], higher S. Bicarbonate [20 vs 17 mEq/L (p ¼ < 0.11)] and higher serum albumin [3 vs 2.3 G/d L (p ¼0.006)] and lower number of ionotropic support at the start of CRRT. Diabetes, S. creatinine , ventilator requirement and Effluent volume were not different between survivors and non survivors. S2
Conclusion: Community acquired AKI was much more common than Hospital acquired AKI. Survival on CRRT was predicted by higher mean BP, s.bicarbonate and s.albumin with lower APACHE II score, Cost of CRRT is a major barrier to its widespread utilisation in India.
036 ACUTE KIDNEY INJURY REFERRAL PATTERN IN TERTIARY CENTRE IN MALAYSIA Abdul Gafor, Abdul Halim, Kong, Wei Yen, Yen, Lim Kah, Mohd, Rozita, Cader, Rizna, Mustafa, Ruslinda, Isfahani, Rizawati Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Prof ABDUL HALIM ABDUL GAFOR Keywords: Acute kidney injury, KDIGO classification, in-hospital
mortality, sepsis, diabetes mellitus Introduction: Acute kidney injury (AKI) is a common clinical problem faced by clinicians. Objectives: This study aimed to characterise the pattern of referral to nephrology unit in a tertiary hospital situated in Kuala Lumpur, Malaysia. Methodology: This was a prospective cohort study of AKI patients referred to nephrology unit from June 2015 to January 2016. Demographic details, aetiologies of AKI and KDIGO staging of AKI were captured. Results: There were 345 patients with AKI referred to nephrology unit during the study period. The median age was 64 years (IQR:54 to 73), 55.7% were male and 62% were medical patients. Majority of the patients were Malays (57.4%), followed by Chinese (32.8%) and Indian (9.6%). Diabetes mellitus (DM) ( 59.1%), hypertension (HPT) (72.8%) and dyslipidaemia (55.4%) were the common co-morbidities. Half of our studied patients (50.7%) had a background of CKD. Sepsis was the commonest aetiology of AKI( 69.6%). There were 54 patients referred at stage 1, 67 at stage 2 and 224 at stage 3 of AKI KDIGO classification. We had 90 referrals from emergency department. 13 patients took discharges against medical advice thus 332 patients were analysed for inhospital mortality . The in-hospital mortality was 41.6% with 46.2% in male and 36.0% in female (p ¼0.062). The mortality rate was 51.5% in Indian, 47.7% in Chinese and 36.5% in Malay ( p¼0.026). There was no significant correlation in between age and in-hospital mortality. Patients with underlying CKD , DM, HPT and dyslipidaemia had significantly higher risk of mortality. As we expected, patients who developed AKI secondary to sepsis had higher risk of in hospital mortality ( p< 0.001). In a logistic regression analysis, only CKD, DM and sepsis were the risk factors for in-hospital mortality Conclusion: Our study revealed that sepsis was the commonest cause of AKI in our centre and and the risk factors of in-hospital mortality include Indian race, background history of CKD, diabetes mellitus, hypertension ,dyslipidaemia and sepsis.
037 THE EFECTS OF TIMING AND AKI STAGES IN OUTCOMES: A SINGLE CENTRE PROSPECTIVE COHORT STUDY Abdul Gafor, Abdul Halim, Kong, Wei Yen, Yen, Lim Kah, Mohd, Rozita, Cader, Rizna, Mustafa, Ruslinda, Isfahani, Rizawati Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Prof ABDUL HALIM ABDUL GAFOR Keywords: Acute kidney injury, KDIGO classification, early referral,
in-hospital mortality, renal recovery, intensive care unit Introduction: Acute kidney injury (AKI) is a common clinical problem
faced by clinicians. Objectives: This study aimed to analyse the influence of timing of
referral and stages of AKI on patients’ outcome. Methodology: This was a prospective cohort study of AKI patients
referred to nephrology unit from June 2015 to January 2016. AKI was diagnosed and classified using KDIGO criteria. AKI was classified as early referral if referral was made within 48 hours of diagnosis and late if referrals were made after 48 hours. Recovery of renal functions were defined as full when the serum creatinine reduced to > 75%, partial from 25-75% and non recovery if < 25% from the peak of serum creatinine Kidney International Reports (2017) 2, S1–S41
1ST ASIA PACIFIC AKI CRRT 2017 Results: There were 345 patients with AKI referred to nephrology unit during the study period. 13 patients took discharges against medical advice thus 332 patients were analysed . There were 54 patients referred at stage 1, 65 at stage 2 and 213 at stage 3 of AKI KDIGO classification. Majority of the patients (90.3%) were referred within 48 hours of diagnosis . The in-hospital mortality was 41.6%. There were no significant correlations between the stages of AKI and the timing of the referral with in-hospital mortality. Patients referred from the intensive care units had a significantly higher in-hospital mortality rate (p< 0.001). Figure 1 revealed the recovery status based on KDIGO classification on 194 surviving patients. The stages of AKI and timing of referral were not a predictor for the renal recovery outcome ( p¼0.428 and p¼ 0.309 respectively) . 71.9% patients from the intensive care units had full recovery compared to 57.7% from the general ward (p¼0.062). Conclusion: Majority of AKI patients were referred at stage 3 and within 48 hours of diagnosis. There was no correlation between time of referral and stages of AKI with mortality and renal recovery . As we expected , patients in intensive care unit had higher rate of in-hospital mortality.
severe AKI during hospitalisation from 1st January 2010 to 31st December 2016 were reviewed. Outcome measures were patient survival and renal function at discharge. Results: We identified 358 patients with 360 episodes of severe AKI from a total of 406 966 patients. Severe AKI rate was 0.88 per 1000 hospitalised patients and 6.4 per 1000 ICU admissions. The median age at presentation was 2.5 years with 56.4% male predominance. 65.6% of this cohort had co-morbid conditions. Aetiology for severe AKI were ischaemia/hypoperfusion 41.9% (of which 80% were due to post cardiac surgery), sepsis 26.1%, glomerular disease 15.6%, haemolytic uraemic syndrome 7.2%, tumour lysis syndrome 3.3%,nephrotoxin 2.8%,inborn error of metabolism 1.9%, obstructive uropathy 1.1%. Severe AKI were associated with ICU admission in 80.6%, mechanical ventilation in 75.6%, use of at least two inotropes in 61.7% and organ dysfunction of two or more in 60.6%. First mode of renal replacement therapy was peritoneal dialysis in 49.2%, haemodialysis in 40.3% and continuous renal replacement therapy in 10.5%. Severe AKI conferred an increased risk of death. Death occurred in 28.6% children with severe AKI compared to 0.97% death of the total admission. Age, hypotension, sepsis, mechanical ventilation and use of two or more inotropes were not statistical significant predictors of death. Better patient survival were seen with glomerular disease (p < 0.0005) and haemolytic uraemic syndrome (p¼0.001). Among the survivors at hospital discharge, mean serum creatinine was 84.9 mcmol/L (CI 72.6 - 97.1), 32.3% had estimated glomerular filtration rate less than 60mls/min/1.73m2 and 2% progressed to end stage renal disease. Conclusion: The incidence of severe AKI is low among our cohort of hospitalised children. Severe AKI increases risk of mortality however short term renal outcome seems good among the survivors. A multi-centre prospective study is needed to validate these findings.
040 MANAGEMENT OF AKI IN TERTIARY CENTRE IN DEVELOPING COUNTRY Abdul Gafor, Abdul Halim, Kong, Wei Yen, Yen, Lim Kah, Mohd, Rozita, Cader, Rizna, Mustafar, Ruslinda, Isfahani, Rizawati
038 EPIDEMIOLOGY & OUTCOME OF ACUTE KIDNEY INJURY IN PAEDIATRIC PATIENTS TREATED WITH RENAL REPLACEMENT THERAPY IN MALAYSIA - A 7 YEARS MULTI-CENTRE REVIEW Lim, HN1, Pee, S1, Yap, YC2, Sidhu, S2, Eng, C3, Lee, ML3, Wanjazilah, WI4, Liaw, L5, Khairulfaizah, MK6, Yap, SL7, Anisuraya, G8 1
Department of Paediatrics, Hospital Sultan Ismail, Johor Bahru, Johor, Malaysia, 2Department of Paediatrics, Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia, 3Department of Paediatrics, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia, 4Department of Paediatrics, Hospital Selayang, Selangor, Malaysia, 5Department of Paediatrics, Hospital Pulau Pinang, Pulau Pinang, Malaysia, 6Institut Jantung Negara, Wilayah Persekutuan, Malaysia, 7Department of Paediatrics, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia, 8Department of Paediatrics, Hospital Serdang, Selangor, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Dr HAN NEE LIM Keywords: severe paediatric acute kidney injury Objectives: As comprehensive epidemiological data of paediatric acute
kidney injury(AKI) are lacking in Malaysia, a multi-center retrospective study was undertaken to define the incidence, aetiology, patient survival and renal outcome of severe AKI. Methods: We defined severe AKI as AKI requiring renal replacement therapy. Paediatric patients age 18 years or less admitted to 8 participating tertiary hospitals who presented with or acquired
Kidney International Reports (2017) 2, S1–S41
Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Prof ABDUL HALIM ABDUL GAFOR Keywords: Acute kidney injury, renal replacement therapy, metabolic
acidosis, in-hospital mortality, renal recovery Introduction: Acute kidney injury (AKI) is a common clinical problem
faced by clinicians. Objectives: To analyse the management of AKI patients in a developing
country. Methodology: This was a prospective cohort study of AKI patients
referred to nephrology unit from June 2015 to January 2016. Patients’ demographic data, management plans and outcomes were captured. Results: There were 345 patients recruited into the study. One hundred and ninety-five patients (56.5%) had renal replacement therapy (RRT). The commonest mode of first RRT was continuous veno -venous hemofiltration (CVVH) (140 patients) followed by conventional intermittent haemodialysis (IHD) (31 patients) and sustained low - efficiency haemodialysis (SLED) (24 patients). The indications for starting RRT is shown in Figure 1. Many patients received different modes of RRT depending of their clinical features and hemodynamic stability. 13 patients took discharges against medical advice thus 332 patients were analysed for in-hospital mortality and renal outcomes. The in-hospital mortality was 41.6%. Patients who received RRT had significantly higher mortality (p<0.001) and did not associate with better renal recovery (p¼0439). Patients who received CVVH had higher mortality rate compared to other modalities (p< 0.001). Conclusion: CVVH was the commonest mode of RRT in our centre. Patients who received RRT had higher in -hospital mortality rate.
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035 EPIDEMIOLOGY, RISK FACTORS AND SURVIVAL OF AKI PATIENTS TREATED BY CRRT - A STUDY FROM RURAL INDIA Sampathkumar, Krishnaswamy, Rajiv, Andrew, Nayak, Aditya, Saravanan, Ratchagan, Kumar, Shakthi, Anandan Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai- 625107, India
Category: Epidemiology and Outcomes from AKI Presenter: Prof KRISHNASWAMY SAMPATHKUMAR Keywords: CRRT, AKI, ICU, Shock, APACHE. Introduction: AKI encountered in ICU is accompanied by shock which
precludes Intermittent Hemodialysis. CRRT is not commonly offered to such patients in many ICUs of India. Objective: A retrospective cohort study of patients with AKI was undertaken in our renal centre which caters to rural population of South India to analyse the epidemiology and survival of patients treated with CRRT. Methodology: Consecutive patients who were treated with CRRT from January 2015 to October 2016 formed the Study Group.The mode of CRRT was uniformly CVVHDF [Prismaflex - Baxter] in all patients with target Effluent volume of 20 ml/Kg/hr with pre filter infusion of commercially available [Prismasol] replacement fluid. APACHE II score was calculated at the point of start of CRRT initiation. Survivors and Non survivors were compared using various clinical and biochemical risk factors. Student’s t-test for quantitative variables and Chi-square (Ïz2) test for qualitative variables were used for comparison. A P < 0.05 was considered statistically significant. Primary outcome was In hospital Survival. Results: 127 patients who developed AKI were offered CRRT out of 1544 patients admitted in ICU [8.2 %]. 12 [9%] of these patients could not afford CRRT. 115 patients were treated with CRRT and formed the study group. Mean age was 50 8 years. 66% were males. Community acquired AKI [89%] was more common than hospital acquired AKI [11%]. Medical [63%] Surgical [28%] and Obstetric [7.8%] AKI were seen. Medical causes included Septic shock [58%], cardiogenic shock [20%], Hepatorenal syndrome [9.5%] and Pancreatitis [7.8%]. Emphysematous Pyelonephritis [8], scrub typhus [2], and Dengue shock syndrome [2] were encountered. Vascular access was mainly via Femoral vein [94%.], CRRT was heparin free in 53% of sessions. 78% required ventilatory support. In hospital survival was 42%. It was predicted by higher Mean BP [ 72 mm Hg vs 62 mm Hg (p <001)], Lower APACHE II score [24 vs 29 (p ¼ < 0.001)], higher S. Bicarbonate [20 vs 17 mEq/L (p ¼ < 0.11)] and higher serum albumin [3 vs 2.3 G/d L (p ¼0.006)] and lower number of ionotropic support at the start of CRRT. Diabetes, S. creatinine , ventilator requirement and Effluent volume were not different between survivors and non survivors. S2
Conclusion: Community acquired AKI was much more common than Hospital acquired AKI. Survival on CRRT was predicted by higher mean BP, s.bicarbonate and s.albumin with lower APACHE II score, Cost of CRRT is a major barrier to its widespread utilisation in India.
036 ACUTE KIDNEY INJURY REFERRAL PATTERN IN TERTIARY CENTRE IN MALAYSIA Abdul Gafor, Abdul Halim, Kong, Wei Yen, Yen, Lim Kah, Mohd, Rozita, Cader, Rizna, Mustafa, Ruslinda, Isfahani, Rizawati Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Prof ABDUL HALIM ABDUL GAFOR Keywords: Acute kidney injury, KDIGO classification, in-hospital
mortality, sepsis, diabetes mellitus Introduction: Acute kidney injury (AKI) is a common clinical problem faced by clinicians. Objectives: This study aimed to characterise the pattern of referral to nephrology unit in a tertiary hospital situated in Kuala Lumpur, Malaysia. Methodology: This was a prospective cohort study of AKI patients referred to nephrology unit from June 2015 to January 2016. Demographic details, aetiologies of AKI and KDIGO staging of AKI were captured. Results: There were 345 patients with AKI referred to nephrology unit during the study period. The median age was 64 years (IQR:54 to 73), 55.7% were male and 62% were medical patients. Majority of the patients were Malays (57.4%), followed by Chinese (32.8%) and Indian (9.6%). Diabetes mellitus (DM) ( 59.1%), hypertension (HPT) (72.8%) and dyslipidaemia (55.4%) were the common co-morbidities. Half of our studied patients (50.7%) had a background of CKD. Sepsis was the commonest aetiology of AKI( 69.6%). There were 54 patients referred at stage 1, 67 at stage 2 and 224 at stage 3 of AKI KDIGO classification. We had 90 referrals from emergency department. 13 patients took discharges against medical advice thus 332 patients were analysed for inhospital mortality . The in-hospital mortality was 41.6% with 46.2% in male and 36.0% in female (p ¼0.062). The mortality rate was 51.5% in Indian, 47.7% in Chinese and 36.5% in Malay ( p¼0.026). There was no significant correlation in between age and in-hospital mortality. Patients with underlying CKD , DM, HPT and dyslipidaemia had significantly higher risk of mortality. As we expected, patients who developed AKI secondary to sepsis had higher risk of in hospital mortality ( p< 0.001). In a logistic regression analysis, only CKD, DM and sepsis were the risk factors for in-hospital mortality Conclusion: Our study revealed that sepsis was the commonest cause of AKI in our centre and and the risk factors of in-hospital mortality include Indian race, background history of CKD, diabetes mellitus, hypertension ,dyslipidaemia and sepsis.
037 THE EFECTS OF TIMING AND AKI STAGES IN OUTCOMES: A SINGLE CENTRE PROSPECTIVE COHORT STUDY Abdul Gafor, Abdul Halim, Kong, Wei Yen, Yen, Lim Kah, Mohd, Rozita, Cader, Rizna, Mustafa, Ruslinda, Isfahani, Rizawati Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Prof ABDUL HALIM ABDUL GAFOR Keywords: Acute kidney injury, KDIGO classification, early referral,
in-hospital mortality, renal recovery, intensive care unit Introduction: Acute kidney injury (AKI) is a common clinical problem
faced by clinicians. Objectives: This study aimed to analyse the influence of timing of
referral and stages of AKI on patients’ outcome. Methodology: This was a prospective cohort study of AKI patients
referred to nephrology unit from June 2015 to January 2016. AKI was diagnosed and classified using KDIGO criteria. AKI was classified as early referral if referral was made within 48 hours of diagnosis and late if referrals were made after 48 hours. Recovery of renal functions were defined as full when the serum creatinine reduced to > 75%, partial from 25-75% and non recovery if < 25% from the peak of serum creatinine Kidney International Reports (2017) 2, S1–S41
1ST ASIA PACIFIC AKI CRRT 2017 Results: There were 345 patients with AKI referred to nephrology unit during the study period. 13 patients took discharges against medical advice thus 332 patients were analysed . There were 54 patients referred at stage 1, 65 at stage 2 and 213 at stage 3 of AKI KDIGO classification. Majority of the patients (90.3%) were referred within 48 hours of diagnosis . The in-hospital mortality was 41.6%. There were no significant correlations between the stages of AKI and the timing of the referral with in-hospital mortality. Patients referred from the intensive care units had a significantly higher in-hospital mortality rate (p< 0.001). Figure 1 revealed the recovery status based on KDIGO classification on 194 surviving patients. The stages of AKI and timing of referral were not a predictor for the renal recovery outcome ( p¼0.428 and p¼ 0.309 respectively) . 71.9% patients from the intensive care units had full recovery compared to 57.7% from the general ward (p¼0.062). Conclusion: Majority of AKI patients were referred at stage 3 and within 48 hours of diagnosis. There was no correlation between time of referral and stages of AKI with mortality and renal recovery . As we expected , patients in intensive care unit had higher rate of in-hospital mortality.
severe AKI during hospitalisation from 1st January 2010 to 31st December 2016 were reviewed. Outcome measures were patient survival and renal function at discharge. Results: We identified 358 patients with 360 episodes of severe AKI from a total of 406 966 patients. Severe AKI rate was 0.88 per 1000 hospitalised patients and 6.4 per 1000 ICU admissions. The median age at presentation was 2.5 years with 56.4% male predominance. 65.6% of this cohort had co-morbid conditions. Aetiology for severe AKI were ischaemia/hypoperfusion 41.9% (of which 80% were due to post cardiac surgery), sepsis 26.1%, glomerular disease 15.6%, haemolytic uraemic syndrome 7.2%, tumour lysis syndrome 3.3%,nephrotoxin 2.8%,inborn error of metabolism 1.9%, obstructive uropathy 1.1%. Severe AKI were associated with ICU admission in 80.6%, mechanical ventilation in 75.6%, use of at least two inotropes in 61.7% and organ dysfunction of two or more in 60.6%. First mode of renal replacement therapy was peritoneal dialysis in 49.2%, haemodialysis in 40.3% and continuous renal replacement therapy in 10.5%. Severe AKI conferred an increased risk of death. Death occurred in 28.6% children with severe AKI compared to 0.97% death of the total admission. Age, hypotension, sepsis, mechanical ventilation and use of two or more inotropes were not statistical significant predictors of death. Better patient survival were seen with glomerular disease (p < 0.0005) and haemolytic uraemic syndrome (p¼0.001). Among the survivors at hospital discharge, mean serum creatinine was 84.9 mcmol/L (CI 72.6 - 97.1), 32.3% had estimated glomerular filtration rate less than 60mls/min/1.73m2 and 2% progressed to end stage renal disease. Conclusion: The incidence of severe AKI is low among our cohort of hospitalised children. Severe AKI increases risk of mortality however short term renal outcome seems good among the survivors. A multi-centre prospective study is needed to validate these findings.
040 MANAGEMENT OF AKI IN TERTIARY CENTRE IN DEVELOPING COUNTRY Abdul Gafor, Abdul Halim, Kong, Wei Yen, Yen, Lim Kah, Mohd, Rozita, Cader, Rizna, Mustafar, Ruslinda, Isfahani, Rizawati
038 EPIDEMIOLOGY & OUTCOME OF ACUTE KIDNEY INJURY IN PAEDIATRIC PATIENTS TREATED WITH RENAL REPLACEMENT THERAPY IN MALAYSIA - A 7 YEARS MULTI-CENTRE REVIEW Lim, HN1, Pee, S1, Yap, YC2, Sidhu, S2, Eng, C3, Lee, ML3, Wanjazilah, WI4, Liaw, L5, Khairulfaizah, MK6, Yap, SL7, Anisuraya, G8 1
Department of Paediatrics, Hospital Sultan Ismail, Johor Bahru, Johor, Malaysia, 2Department of Paediatrics, Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia, 3Department of Paediatrics, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia, 4Department of Paediatrics, Hospital Selayang, Selangor, Malaysia, 5Department of Paediatrics, Hospital Pulau Pinang, Pulau Pinang, Malaysia, 6Institut Jantung Negara, Wilayah Persekutuan, Malaysia, 7Department of Paediatrics, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia, 8Department of Paediatrics, Hospital Serdang, Selangor, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Dr HAN NEE LIM Keywords: severe paediatric acute kidney injury Objectives: As comprehensive epidemiological data of paediatric acute
kidney injury(AKI) are lacking in Malaysia, a multi-center retrospective study was undertaken to define the incidence, aetiology, patient survival and renal outcome of severe AKI. Methods: We defined severe AKI as AKI requiring renal replacement therapy. Paediatric patients age 18 years or less admitted to 8 participating tertiary hospitals who presented with or acquired
Kidney International Reports (2017) 2, S1–S41
Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Category: Epidemiology and Outcomes from AKI Presenter: Prof ABDUL HALIM ABDUL GAFOR Keywords: Acute kidney injury, renal replacement therapy, metabolic
acidosis, in-hospital mortality, renal recovery Introduction: Acute kidney injury (AKI) is a common clinical problem
faced by clinicians. Objectives: To analyse the management of AKI patients in a developing
country. Methodology: This was a prospective cohort study of AKI patients
referred to nephrology unit from June 2015 to January 2016. Patients’ demographic data, management plans and outcomes were captured. Results: There were 345 patients recruited into the study. One hundred and ninety-five patients (56.5%) had renal replacement therapy (RRT). The commonest mode of first RRT was continuous veno -venous hemofiltration (CVVH) (140 patients) followed by conventional intermittent haemodialysis (IHD) (31 patients) and sustained low - efficiency haemodialysis (SLED) (24 patients). The indications for starting RRT is shown in Figure 1. Many patients received different modes of RRT depending of their clinical features and hemodynamic stability. 13 patients took discharges against medical advice thus 332 patients were analysed for in-hospital mortality and renal outcomes. The in-hospital mortality was 41.6%. Patients who received RRT had significantly higher mortality (p<0.001) and did not associate with better renal recovery (p¼0439). Patients who received CVVH had higher mortality rate compared to other modalities (p< 0.001). Conclusion: CVVH was the commonest mode of RRT in our centre. Patients who received RRT had higher in -hospital mortality rate.
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