Trained clinicians and nephrologists are now able to pre-empt chances of several medical illnesses developing into acute kidney injury (AKI) in hospitals across the country. This has led to prevent fatality rates going up by their expertise to recognize the condition at an early stage, expressed healthcare providers across the country.

Going by the seriousness of the issue and the need for its early diagnosis, this year’s World Kidney Day 2013, observed annually on March 14, revolves around the theme acute kidney injury.

Dr Sanjiv Jasuja, senior consultant, nephrology, Apollo Hospitals, New Delhi, pointed out that AKI is a growing concern in India as its incidence is anywhere between six to 50 per cent in hospital intensive care units (ICU). But hospitals are equipped to handle AKI in the early stages where patients are sufficiently dehydrated. However, for those in an advanced stage dialysis is the only option.

Hospitals like Apollo too report an incidence of 20 per cent. Outside hospital environment in the community AKI incidence is two per cent, occurring due to diarrhoea, hypertension, pancreatitis pregnancy related disorders, besides inflections like malaria and leptospirosis. Drugs like pain killers, certain antibiotics and contrast agents used in angiography are some of the factors leading to this condition. Patients vulnerable to AKI report increased creatinine and urine protein. While survival rates are higher in the community, hospitals report an alarming 50 per cent mortality occurring due to multi organ dysfunction syndrome (MODS), said Dr Jasuja.

According to Dr H Sudarshan Ballal, consultant – nephrologist, and chairman, Medical Advisory Board & Medical Director, Manipal Health Enterprises Pvt. Ltd., AKI is a temporary failure of both the kidneys, which may be associated with MODS in an ICU setting, It affects five to seven per cent of all admissions in any hospitals. It occurs in 10-25 per cent of patients admitted to any ICU, of these six per cent require temporary dialysis.

While there is no database to monitor AKI, we presume there is a high incidence in the rural areas too. Many of the cases go unrecognised due to lack of proper medical surveillance, said Dr Ballal.

Most hospitals in the urban, developed areas and some centres in the districts are equipped to do peritoneal dialysis, IV supportive care and physicians guidance. The major cities in the country have several dialysis centres and are well equipped to undertake hemodialysis, CAPD, and CRRT in the ICU. There are also stand-alone dialysis centres that take care of maintenance hemodialysis for the stable patients, thereby reducing the burden on the hospitals, said Dr S Krishnan, medical director, NephroPlus.

No age group is exempt from this disorder. The disease is very common in the young age groups. But the subtle presentations seen in children and the elderly needs to carefully evaluated and treated early. Child bearing age group in women is also vulnerable to AKI for several reasons, said Dr Krishnan.