P61 Incidence, risk factors and prognose of acute kidney injury in critically ill patients: a prospective cohort study in brazilian amazon

Background Epidemiological studies, mainly prospective population-based studies, of acute kidney injury (AKI) are still scant, especially in low-income and middle-income countries (>85% of the world’s population). This study aimed to identify incidence and factors associated AKI in critically ill patients of Brazilian Amazon, a region with limited health care facilities. Methods Prospective cohort study of all adult patients without chronic renal disease admitted, and staying >2days, in all Intensive Care Units(ICU) of Rio Branco, the largest city in Acre State, covering approximately 70% of the state population (800,000 inhabitants), from Feb 2014 to Feb 2016. Incidence, risk factors and outcomes of AKI (diagnosed by KDIGO criteria) were evaluated. Patients were followed for up to 7 days, discharge or death. Mortality was assessed 30d after ICU discharge. Factors associated with AKI development and, in those with incident AKI, associated with mortality were evaluated in multiple logistic regression analysis. The proportional multiple Cox analysis evaluated 30-day mortality in non-AKI and AKI patients, using SPSS(v.22.0) software. Results Of 1,494 patients admitted, 1,073 fulfilled selection criteria. AKI incidence was 52% (Stage 1=62.1%, 2=15.6% and 3=22.2%; 8.2% received dialysis). 60% of patients were admitted due to clinical condition, 25% were hemodynamically unstable, 19% had respiratory failure. Only 2.2% had tropical diseases. Risk factors for AKI were age (adjusted OR(aOR) 1.2[CI95% 1.1–1.3 for 10 years increase]), positive fluid balance >1500 ml/24h (aOR 2.9[2.1–3.9]), APACHE score (aOR 1.06[1.04–1.07 per unit increase]), clinical patients (reference surgical: aOR 1.6[1.2–2.6]). AKI had higher ICU mortality (AKI 43.4% vs non-AKI 13.9%). AKI mortality was associated with age (aOR 1.3[1.1–1.4 for 10 years increase]), mechanical ventilation (aOR 5.2[3.0–9.0]), KDIGO stage 3 (ref 1) (aOR 1.6[1.03–2.5]), vasoactive drugs or shock (aOR 2.6[1.4–4.7]), and sepsis (aOR 2.3[1.6–4.7]). Adjusted AKI hazard for 30 days after ICU discharge mortality was 1.8 (1.1–3.0). Conclusion AKI incidence was strikingly high in critically ill patients in the Brazilian Amazon. Hospitalizations due to tropical diseases were rare, likely due to particular conditions of the Amazon area, with difficulty access to larger cities and limited health care facilities. AKI etiology and risk factors were similar to those seen in developed countries. However, mortality rates were higher. The follow-up of the cohort was for7 days and data collected may not represent all factors affecting outcomes. Poor social-economic conditions and infrastructure of health services may explain the high incidence and mortality rates for AKI observed. The results may contribute to the care of this group of patients.