Precipitating factors and patient outcomes in acute kidney injury treated with renal replacement therapy.

Acute kidney injury (AKI) is not uncommon in acute hospital admissions. AKI treated with renal replacement therapy (RRT) has a wide spectrum of causes and the mortality rate at 90 days, approaches 50%. This study was performed to analyse the identifiable causes and outcomes of all cases of AKI treated with RRT in the Glasgow Royal Infirmary (GRI) renal wards during 2007. This study identified 65 cases of AKI treated with RRT from the GRI renal unit electronic patient record (EPR). Causes of AKI, modality of RRT and patient outcomes were retrieved from the EPR and discharge letters. The main outcome measures were the mortality rate and the percentage of patients still receiving RRT at 90 days. More than one precipitating factor was identified in half of the cases of dialysis-dependent AKI. Sepsis, hypovolaemia and nephrotoxic drugs were the main contributory factors and were observed in 52%, 40% and 23% of the cases, respectively. The mortality rate was 29% at 90 days. This study shows that the aetiology of AKI is often multifactorial and the 90-day mortality rate of AKI treated with RRT is still high.