Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : OC35 - OC39 Full Version

Clinical Profile, Need for Dialysis and Mortality of Community Acquired versus Hospital Acquired Acute Kidney Injury


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49408.15221
B Dushyanth, Archana Dambal, Siddaganga, CP Vrushabhveer, CS Hithashree

1. Junior Resident, Department of General Medicine, SDM College of Medical Sciences and Hospital, Affiliated to Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India. 2. Professor, Department of General Medicine, SDM College of Medical Sciences and Hospital, Affiliated to Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India. 3. Assistant Professor, Department of General Medicine, SDM College of Medical Sciences and Hospital, Affiliated to Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India. 4. Junior Resident, Department of General Medicine, SDM College of Medical Sciences and Hospital, Affiliated to Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India. 5. Junior Resident, Department of General Medicine, SDM College of Medical Sciences and Hospital, Affiliated to Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India.

Correspondence Address :
Dr. Archana Dambal,
Professor, Department of General Medicine, SDM College of Medical Sciences and
Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University,
Dharwad, Karnataka, India.
E-mail: archanadambalmedicine@gmail.com

Abstract

Introduction: Occurrence of Acute Kidney Injury (AKI) is high in hospitalised and critically ill patients. Most of the cases reported by the developed countries are Hospital Acquired Acute Kidney Injury (HA-AKI). AKI is a major medical complication in the developing world also and is due to predominantly community acquired causes, where the epidemiology differs from that in developed countries. Many studies have reported that Community Acquired Acute Kidney Injury (CA-AKI) and HA-AKI differ in mortality, need for renal replacement and residual renal injury.

Aim: To know the difference in need for renal replacement therapy and in-hospital mortality between patients diagnosed with CA-AKI and HA-AKI using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.

Materials and Methods: A prospective cohort study was conducted from January 2018-December 2018 after obtaining Institutional Ethical Clearance by comparing 50 cases of CA-AKI and 50 cases of HA-AKI admitted by the General Medicine Department as per the inclusion and exclusion criteria. Serum Creatinine (S.Cr) at admission, after 48 hours and at the time of discharge were measured. Serial urine output measurements were done. Need for dialysis was noted in both the groups. Both groups were compared based on need for dialysis, difference in mortality and residual renal injury at the time of discharge. Chi-square and student t-tests were applied respectively and p-value ≤0.05 was considered as significant. Statistical Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis.

Results: The CA-AKI and HA-AKI groups were comparable in age and gender but differed in some co-morbidities. CA-AKI group had underlying hepatobiliary disorders and Non steroidal Anti-Inflammatory Drug (NSAID) abuse more often than HA-AKI group. There was a significant reduction in S.Cr over the duration of hospital stay in CA-AKI (mean S.Cr at admission was 4.85 mg/dL, at 48 hours 2.05 mg/dL and at discharge 1.20 mg/dL). S.Cr increased after 48 hours of admission from baseline and declined later in HA-AKI but did not reach baseline in many patients in comparison to CA-AKI group (mean S.Cr at admission was 1.10 mg/dL, at 48 hours 2.38 mg/dL, at discharge 1.57 mg/dL). The highest stage of AKI was stage 3 in CA-AKI group (22 vs 11 of HA-AKI). HA-AKI group had more number of patients in stage 2 AKI (26 vs 18 of CA-AKI). There was no significant difference in mortality and requirement of haemodialysis between CA-AKI and HA-AKI groups.

Conclusion: There was no difference between the two groups in terms of mortality and need for renal replacement therapy but there was significant residual renal injury in HA-AKI group.

Keywords

Hospital mortality, Renal replacement, Residual renal injury, Risk factors, Serum creatinine

The AKI is a disease presenting with a range of disorders from asymptomatic with transient changes in laboratory parameters to derangements in intravascular volume, electrolyte and acid-base composition of the plasma often causing persistent renal dysfunction or deaths (1). It is defined and staged by three systems: Risk, Injury, Failure, Loss and End-stage definition (the RIFLE), Acute Kidney Injury Network (AKIN), KDIGO the last being accepted since 2012 (2),(3),(4).

The AKI comprises of 5-7% of acute care hospital admissions and up to 30% intensive care admissions. It is associated with increased risk of death in hospitalised individuals, particularly in those admitted to the ICU with mortality rates exceeding 50% (1). It is a risk factor for the development of Chronic Kidney Disease (CKD). Severity of illness is directly proportional to the number of co-morbidities (5). Even stage 1 and 2 AKI can result in CKD, high socio-economic burden for the family and mortality. Even such small increase in S.Cr as 0.5 mg/dL is associated with 6.5-fold increase in odds of death, 3.5-days increase in length of hospital stay and $7500 in excess hospital cost (6).

Most of the cases reported by the developed countries are HA-AKI. HA-AKI is defined as AKI developing in 48 hours following hospital admission (4),(7).

The HA-AKI is that group of patients in whom S.Creatinine increases by atleast 1.5 times above admission value during hospitalisation. HA-AKI is usually associated with one or more of three renal insults that includes prerenal events, exposure to nephrotoxins and sepsis. The causes of HA-AKI reported in Spain and France were prerenal (17-21%), acute tubular necrosis (53-78%) and obstructive (5-10%) (8),(9).

Risk factors for HA-AKI include postoperative state, advanced cardiovascular disease, nephrotoxic drugs, neoplastic disease, hospital acquired infection, multiple organ failure, sepsis and solid organ transplantation. Patients with impaired left ventricular systolic function, advanced age commonly defined as >75 years of age, diabetes and dehydration are at particularly high risk of AKI. In addition, specific surgery-related factors including time spent on heart-lung machine, the use of an intra-aortic balloon pump, need for blood transfusions and haemodilution are associated with AKI (7),(10).

In the developing countries; incidence, clinical features and outcome of AKI are influenced by environmental, economic and aetiological factors besides healthcare seeking behaviour (11),(12). AKI is reported in 7% of hospitalised patients and 36-67% of critically ill patients. The causes for AKI in a tropical country like India are a variety of illness like malaria, gastroenteritis, snakebites, toxins and sepsis (1). CA-AKI is that group of patients in whom S.Cr is elevated at the time of admission. Many studies have reported that incidence of CA-AKI was two to three times more than HA-AKI but carried same prognostic significance as HA-AKI in terms on mortality, longer length of stay and higher healthcare cost (7),(13),(14). So, this study was conducted to know the difference in need for renal replacement therapy and in-hospital mortality between patients diagnosed with CA-AKI and HA-AKI using KDIGO criteria in patients admitted to general medicine wards.

Material and Methods

A prospective cohort study was conducted from January 2018-December 2018 after obtaining Institutional ethical clearance at General Medicine Department of Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, Karnataka, India. Informed consent was obtained from all the study participants.

Sample size calculation: Hundred patients above 18 years of age with AKI as defined by KDIGO criteria were enrolled by convenience sampling (4). Prevalence of AKI in the department was 33.5% during 2017. The formula n=z2pq/d2 was applied, where z=1.96, with 95% confidence interval and d=20 was considered. So, the sample size was estimated at 96 and rounded up to 100.

Inclusion and Exclusion criteria: Fifty patients of CA-AKI and 50 patients of HA-AKI were selected by convenience sampling for describing the clinical profile. The patients who received renal transplant or dialysis within a year of admission or patients with CKD were excluded.

Study Procedure

Demographic data, history, prior co-morbidities, clinical examination, investigations undertaken to arrive at the diagnosis, provisional diagnosis, need for renal replacement therapy and in-hospital mortality were recorded. AKI was diagnosed as per KDIGO criteria (4). S.Cr measurements were made at admission, 48 hours and discharge in milligrams per decilitre. Urine output measurements in millilitres were noted.

Statistical Analysis

Numerical data were represented as proportions and percentages and continuous data as mean±standard deviation. Chi-square and student t-tests were applied for significance. The p-value ≤0.05 was considered as significant. S.Cr and urine output were compared between HA-AKI and CA-AKI groups using independent t-test. Time trends comparison in each group was done by dependent t-test. Mortality rate and need for dialysis were compared between HA-AKI and CA-AKI by using Chi-square test. The SPSS version 17.0 was used for data entry and analysis.

Results

The baseline characteristics of the patients are depicted in (Table/Fig 1), (Table/Fig 2). Mean age±standard deviation was 58.98±15.52 years in CA-AKI and 52.22±16.32 years in HA-AKI group.

The CA-AKI and HA-AKI were comparable in age and gender, but differed in co-morbidities (type 2 diabetes mellitus and ischemic heart disease) which were more often seen in CA-AKI patients. CA-AKI and HA-AKI differed at admission in their diagnosis significantly (p=0.002) as shown in (Table/Fig 3).

There was higher S.Cr in CA-AKI at admission in comparison to HA-AKI (statistically insignificant) whereas it was similar at 48 hours of admission. But at the time of discharge the S.Cr persisted at higher levels in HA-AKI in comparison to CA-AKI (Table/Fig 4).

There was a significant reduction (p<0.05) in S.Cr over the duration of hospital stay in CA-AKI. S.Cr increased after 48 hours of admission from baseline and declined later in HA-AKI as shown in (Table/Fig 5).

There was a significant difference in urine output between CA-AKI and HA-AKI at admission with CA-AKI having lower urine output not amounting to oliguria. At 48 hours of admission, HA-AKI patients had lower urine output. In both the groups, the urine output improved at discharge (Table/Fig 6).

There was a trend of increasing urine output among CA-AKI patients till discharge. However, HA-AKI patients had a dip in urine output at 48 hours that improved subsequently (Table/Fig 7). There was a significant difference between all time points in CA AKI group, however there was no significant difference between the baseline and the discharge in HA-AKI group (Table/Fig 7).

There were more cases of stage 3 in CA-AKI group in comparison to HA-AKI whereas HA-AKI group had more number of patients in stage 2 as shown in (Table/Fig 8).

More number of patients with CA-AKI had prerenal AKI and intrinsic causes of AKI were more in HA-AKI (Table/Fig 9). This difference was statistically significant (Chi-square=17.6890, p-value 0.0010).

There was no significant difference in requirement of haemodialysis (Table/Fig 10) and mortality (Table/Fig 11) between CA-AKI and HA-AKI groups.

Discussion

The CA-AKI occurs in younger patients due to tropical infectious diseases, diarrhoeal disorders or complicated pregnancies in developing countries even before arrival to the hospital where as HA-AKI occurs in older patients due to sepsis, nephrotoxic drugs and hospital acquired infections in developed countries after admission to hospital (15),(16).

The pattern of age distribution, co-morbidities and aetiology contrary to expectations in CA-AKI in our study may be attributed to the fact that ours is a medical college hospital situated in urban area receiving referred cases from many districts of North Karnataka. There is also ease of availability of NSAIDs over the counter contributing to CA-AKI cases contrary to other studies (17),(18),(19).

Patients with CA-AKI had high S.Cr at admission which were comparable to those of HA-AKI and reached normal range at the end of hospital stay. This may be related to the diagnostic criteria for CA-AKI. None of the CA-AKI patients had baseline S.Cr values prior to admission. In contrast, HA-AKI patients had persistent and residual increased S.Cr at the end of hospital stay.

The normalisation of S.Cr may be attributed to the prerenal azotemia in CA-AKI and its persistent increased values reflect intrinsic renal injuries in HA-AKI. This was similar to study done by Der Mesropian PJ et al., which concluded that CA-AKI had better glomerular filtration rate (71.3 vs 61.1 mL/min/1.73 m2) and lower prevalence of CKD (43.8 vs 29.1) at baseline and had similar long-term consequences to HA-AKI (20).

The urine output was lower in CA-AKI patients at admission, improved at 48 hours and continued to improve till the end of hospital stay. The urine output reduced from previously normal values at 48 hours in HA-AKI patients. At the end of hospital stay both the groups had similar urine output. The mismatch between urine output and S.Cr among patients of HA-AKI at the end of hospital stay is explained as change in S.Cr follows improvement in urine output in patients with intrinsic renal disease.

There were more cases of stage 3 in CA-AKI group in comparison to HA-AKI whereas HA-AKI group had more number of patients in stage 2. This may be because of early recognition of AKI among HA-AKI patients and preventive measures undertaken in hospital. The number of CA-AKI patients in stage 3 was more than in stage 1. This was different from another study conducted in south India where both stage 1 and stage 3 were 37% and stage 2 were 24%. In the present study increase in number of patient in stage 3 is due to late healthcare seeking behaviours as as the present was the private hospital is private hospital (7).

There was no statistically significant difference between the two groups in mortality and requirement of renal replacement therapy in the present study. According to study done by Hsu CN et al., HA-AKI had more severe outcomes than CA-AKI in the form of increased mortality, longer duration of hospital stay and need for dialysis (11).

Wonacott A et al., conducted a prospective study in United States of America in which patients with CA-AKI had better survival than patients with HA-AKI. Mortality in CA-AKI was 45% as compared to 62.9% in HA-AKI, however renal outcomes were similar in both CA-AKI and HA-AKI (39.4% vs 33.6%) in developing CKD or progression of pre-existing CKD within 14 months (21).

In a study conducted by Priyamvada PS et al., the mortality was not different between CA-AKI and HA-AKI (56% vs 48%). Bhadade R et al., reported high mortality in ICUs due to tropical illnesses and multiorgan failure (51.9%) though the present mortality rates were lower (2% vs 10%). This difference in mortality rates in comparison to the study by Priyamvada PS et al., may be due to early referral to nephrologists, early initiation of volume resuscitation and sepsis bundle of care as discussed by Yang L although convenience sampling could also have biased the results (7),(22),(23).

Limitation(s)

The present study could have been influenced by small sample size and convenience sampling. The follow-up of the patients only up to discharge was done. Further studies with larger sample size can be conducted in future.

Conclusion

The differences between CA-AKI and HA-AKI in need for renal replacement and mortality during hospital stay are influenced by underlying co-morbidities and diagnosis at admission. However the long-term outcomes are likely to be different as there is a significant residual renal injury in HA-AKI.

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DOI and Others

10.7860/JCDR/2021/49408.15221

Date of Submission: Mar 12, 2021
Date of Peer Review: Mar 29, 2021
Date of Acceptance: May 29, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 14, 2021
• Manual Googling: Mar 31, 2021
• iThenticate Software: May 20, 2021 (11%)

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