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Original Research: LUNG INFECTION |

Incidence and Prognostic Implications of Acute Kidney Injury on Admission in Patients With Community-Acquired Pneumonia

Ahsan R. Akram, MBChB; Aran Singanayagam, MBChB; Gourab Choudhury, MBBS; Pallavi Mandal, MBBS; James D. Chalmers, MBChB; Adam T. Hill, MD; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators
Author and Funding Information

From the Department of Respiratory Medicine, New Royal Infirmary of Edinburgh, Edinburgh, Scotland.

Correspondence to: Ahsan R. Akram, MBChB, Department of Respiratory Medicine, New Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Rd, Edinburgh, EH16 4SA, Scotland; e-mail: ahsan.akram@hotmail.co.uk


This work was presented at the British Thoracic Society Winter Meeting, London, 2009. [Akram AR, Singanayagam A, Choudhury G, Mandal P, Chalmers JD, Hill AT. Acute kidney injury on admission independently predicts need for dialysis and 30-day mortality in patients with pneumonia. Thorax 2009;64(suppl 4):A62-A64.]

Funding/Support: Dr Chalmers is supported by a Clinical Research Training Fellowship from the Medical Research Council.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):825-832. doi:10.1378/chest.09-3071
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Background:  A consensus definition of acute kidney injury (AKI)—the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) classification—predicts mortality in general hospital and ICU populations. We aimed to assess its value on admission in patients with community-acquired pneumonia (CAP).

Methods:  A prospective observational study with CAP was carried out. We classified each patient according to his or her maximum RIFLE class using admission creatinine (risk, ≥ 1.5 × baseline creatinine; injury, ≥ 2 × baseline; failure, ≥ 3 × baseline; no-AKI, < 1.5 × baseline). Outcomes were 30-day mortality, requirement for mechanical ventilation and inotropic support (MV/IS), and requirement for renal replacement therapy (RRT).

Results:  A total of 1,241 patients were included (no-AKI, 1,018; risk, 130; injury, 63; failure, 30). On multivariate analysis, factors predicting development of AKI include severity of pneumonia (adjusted odds ratio [AOR], 1.74; 95% CI, 1.46-2.08; P < .0001), elevated C-reactive protein (AOR, 1.04; 95% CI, 1.03-1.06; P < .0001), and prior use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II-receptor blockers (AIIBs) (AOR, 1.77; 95% CI, 1.19-2.58; P = .005). Adjusting for severity of pneumonia, RIFLE criteria independently predicted 30-day mortality (AOR, 1.48; 95% CI, 1.15-1.91; P = .002), requirement for MV/IS (AOR, 2.22; 95% CI, 1.74-2.83; P < .0001), and RRT (AOR, 3.20; 95% CI, 2.01-5.11; P < .0001). Prior use of ACEIs or AIIBs was not associated with adverse outcome in either the entire cohort or patients without AKI.

Conclusion:  The RIFLE classification is a simple tool to assess and classify AKI on admission and independently predicts 30-day mortality and the need for MV/IS and RRT in patients with CAP.

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