| Abstract |
Background: Regardless of the primary disease, Acute Kidney Injury (AKI) is an additional aggravating factor that increases hospital morbidity and mortality. It has been estimated that among patients in the intensive care unit (ICU) who are on mechanical respiratory support, 5% - 35% will develop at some stage of hospitalization some degree of acute kidney injuries, associated with a mortality of more than 20%. The occurrence of this complication is one of the most serious clinical parameters of the complex problem of the critically ill ICU patient. Kidney damage that develops in critically ill patients is usually severe with the most common causes being multi-organ failure, septic shock, rhabdomyolysis (eg in cases of multiple injuries) and after severe heart surgery.
Objective: The purpose of the present study is to study the characteristics of ICU patients of PAGNI who underwent extrarenal dialysis, to investigate the signs of onset, risk factors as well as possible complications but also to observe the outcome of patients after discontinuation of extrarenal dialysis.
Methods: The type of research conducted was a retrospective monocentric study. The research took place in the Intensive Care Unit of the University General Hospital of Heraklion. For the data collection, there has been a study conducted as well as a track of data records of patients admitted to the ICU between 2017-2019, who developed Acute Kidney Injury 48 hours after their admission to the ICU. These data were analyzed through the statistical software SPSS.
Results: From 2017 to 2019, 22.2% of patients hospitalized in the ICU were placed on continuous hemofiltration of which the main factor of insertion to ICU and CRRT initiation was sepsis in 32% of all patients treated with clearance. High urea levels >200 mg/dl showed 10% of patients, hyperkalemia with K>5 meq/l in 10% of patients and severe oxyemia with pH<7.25 40% of patients, making up indicators that contribute significantly to the initiation of continuous hemofiltration. Of the patients, 67% needed transfusion of concentrated red blood cells while receiving continuous hemofiltration. A significant number of patients who received the antibiotic Collistin eventually needed continuous hemofiltration. In the patients of the research, it was found that of the 45 patients who initiated hemofiltration after day 7, 41 (91%) had started treatment with colistin. Of the patients who, upon leaving the ICU, needed hemofiltration in the year 23% had passed away, 27% remained on intermittent dialysis and 50% no longer needed dialysis.
Conclusion: High urea levels, electrolytic disorders and balance disorders contribute significantly to the initiation of extraneal clearance, with the last one being the most common cause. Sepsis is the most common cause of insertion to ICU. Patients in continuous hemofiltration also often need a large number of transfusions. In addition, the use of colistin is very common in patients who are slowly enrolled in continuous hemofiltration, indicating a possible causal association. Concerning the outcome of patients approximately 1 in 4 died within the year, with the main pre-availability factor age. Of the patients who came out with renal support, 50% no longer needed it after a year.
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