Risk factors associated to hospital mortality in patients with acute kidney injury on hemodialysis.
BACKGROUND
The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients.


OBJECTIVE
To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients.


METHODS
This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis.


RESULTS
We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97).


CONCLUSIONS
Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients.
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú. Address: Batallón Tarma 428, Santiago de Surco, Lima, Perú. Email: malili0301@hotmail.com.
Mariela Alejandra
MA
Linares-Linares
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
Jorge Arturo
JA
Figueroa-Tarrillo
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
Renato
R
Cerna Viacava
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú; Servicio de Cuidados Intensivos, Hospital de Emergencias Pediátricas, Lima, Perú.
Nilton Yhuri
NY
Carreazo
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú; Unidad de Hemodiálisis, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.
Renzo P
RP
Valdivia-Vega
D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000368:Aged; D062186:Arterial Pressure; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D011188:Potassium / Q000097:blood; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors
D019344:Lactic Acid; D011188:Potassium
 hospital mortality;  renal dialysis;  risk factors; acute kidney injury