Risk factors and outcomes of acute decompensation in patients with chronic kidney disease

Abstract

Introduction: The occurrence of acute decompensation in patients with background chronic kidney disease (CKD) is very common and further worsens the patient's outcome. Because of the limited data on the risk factors and outcomes of acute-on-chronic kidney failure (ACKF), we sought to assess the common causes of acute decompensation in non-dialytic CKD patients necessitating emergency dialysis and to assess the relationship between these risk factors and outcomes. Materials and Methods: We analysed the data of adults ACKF patients admitted to the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, between December 2009 and March 2011. One hundred and sixty-three CKD patients with AKI were recruited. Laboratory data, including complete blood count, biochemical and microbiological analyses, were documented. Two-dimensional and Doppler echocardiography was performed where indicated. Multivariable logistic regression analysis was used to analyse the association between the risk factors for ACKF and in-hospital mortality. Results: The median age was 39 (28–52) years, with male preponderance (76.7%). The common causes of acute decompensation of CKD identified were heart failure (41.7%), malignant hypertension (39.9%), sepsis (35.6%), nephrotoxins (20.9%) and hypovolemia (16. 9.8%). In-hospital mortality was recorded in 34.4% of the patients. Adjusted odds of in-hospital mortality were significantly increased in the presence of heart failure (odds ratio [OR], 2.93 [95%, 1.14–7.55]; P = 0.026) and malignant hypertension (OR, 3.69 [1.15–11.81]; P = 0.028). Conclusion: The risk factors for ACKF such as heart failure and malignant hypertension are also the independent predictors of in-hospital mortality. Given the high mortality rates, aggressive management of these precipitants could be life-saving.