3 Early Acute Kidney Injury (AKI) Following Major Burns

Abstract

Abstract Introduction AKI is increasingly recognized as a major complication of burn injury. No studies have specifically examined early AKI in burn patients. The purpose of this study was to examine AKI that develops within the first 7 days of burn injury. Methods Retrospective review of adults with burns > 20% TBSA admitted within 24 hours of injury to an adult regional ABA-verified burn center from 24/11/15 to 1/7/19. We excluded patients that died or who received palliation in the 1st 24 hours following the burn. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) urine and serum creatinine (s-Cr)-based criteria. The day of burn was defined as day 0. The intake to output ratio in the 1st 24 hours (I:O) was defined as total fluid Intake (mL/kg/%TBSA burn) / urine output (mL/kg). Sepsis was defined using the ABA criteria. Values are presented as median (1st-3rd IQR). Results We included 85 patients with age 46 (31.5–57) yrs., %TBSA burn 30 (23.5–46.9), and 34% with bronchoscopy-confirmed inhalation injury. AKI developed in 53 cases (62.4%) at 0 (0–1) days (range 0–6 days) post burn. Baseline s-Cr was 0.94 mg/dL (0.78–1.24), and peaked at 1.33 mg/dL (1.08–2.24), (P< 0.001). Distribution of AKI severity was 55% Stage I, 19% Stage II, 9% Stage III, and 17% Stage III requiring renal replacement therapy (RRT). No AKI cases had high voltage electrical burns, while 5 (9%) had sepsis and 5 (9%) were receiving vancomycin or an aminoglycoside prior to AKI onset. Comparison of AKI patients to NO AKI patients is shown in the table. High dose vitamin C resuscitation (HDVCR) had been utilized in 78% of the Stage III cases that required RRT. Compared to resuscitation using Ringers Lactate with or without 5% albumin (N= 61), HDVCR was used in 20 (38%) of AKI cases Vs. 4 (13%) of NO AKI cases (p=0.01). The I:O was 0.25 (0.16–0.46) in AKI and 0.19 (0.1–0.33) in NO AKI (p=0.04). Mortality was significantly higher in AKI than NO AKI (38% Vs. 9%, p=0.004) Conclusions Early AKI is highly prevalent following a major burn injury. Patients developing early AKI had significantly greater age, need for mechanical ventilation, and admission SOFA scores. HDVCR may be implicated in the development of early AKI. Applicability of Research to Practice Further study is required on HDVCR’s relationship to AKI.