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MO296: Seasonal Variations in AKI Incidence and Outcomes


 
 
 Kuwait enjoys a cool winter but suffers a very hot summer. We aim to evaluate the relationship between weather temperature and acute kidney injury (AKI) incidence and outcome.
 
 
 
 We prospectively collected demographic (age, sex and nationality), clinical (CKD status, cause of AKI and comorbidities), management (fluids, diuretics, inotropes, ventilatory support and dialysis) and 30-day patients and kidney outcome data for all adult nephrology consultations for AKI in seven major public hospitals in Kuwait during January, February and March/2021 and compared them to those of June, July and August/2021.
 
 
 
 A total of 2038 patients with AKI were enrolled (mean age: 64; males: 59%, Kuwaitis: 58%; mean eGFR: 66.5; mean initial Hgb: 106). Of the cohort, 42% had baseline eGFR < 60 (with a mean eGFR of 37, a mean age of 68 and a mean Hgb of 102 versus a mean eGFR of 88, a mean age of 59 and a mean Hgb of 109 for the group with baseline eGFR > 60). Higher percentage of AKI cases took place in cooler months (63% versus 37%). Patients with AKI in cooler months were significantly older (65 versus 59), with lower baseline eGFR (63 versus 72.5) and more comorbidities (DM, HTN, CAD). There was no difference between the two groups in the use of IV fluids (saline, bicarbonate, blood products, etc.) or IV diuretics (loop, thiazide or potassium-sparing); however, IV vasopressors were used more often in cooler months in cases of AKI. Mechanical ventilation was more frequently used in the summer cases (44% of summer AKI cases versus 40% of winter AKI cases) but not statistically significant. Dialysis was needed for 44% of the entire cohort, 56% of dialysis cases were in cooler months (31% of winter AKI cases) and 44% in summer months (40% of summer AKI cases). Dialysis modality was continuous in 85% of all cases. At 30 days, 36.5% of the total cohort died; 72% of them died while on dialysis. Larger proportion of deaths in AKI cases in cooler months (58% of total deaths or 33% of the winter AKI cases versus 42% of the total death or 42% of the summer AKI cases), with more deaths while on dialysis seen in cooler months too (56% versus 44% of deaths while on dialysis). However, lower rates of complete recovery from AKI were seen in summer cases (33% versus 67%), with a mean final eGFR of 57 for the winter AKI cases versus 41 for the summer AKI cases.
 
 
 
 AKI is more common in the cooler months of the year affecting an older group of patients with more comorbidities, and is associated with higher usage of dialysis and higher rates of death, but probably better chances of kidney recovery in those who survive.
