Clinical Profile, Etiological Spectrum, Kidney Disease: Improving Global Outcomes Staging, and Predictors of Outcome in Acute Kidney Injury: A Prospective Study from a Medical Intensive Care Unit in Central India

Abstract

Background: Acute kidney injury (AKI) in critically ill patients carries high morbidity and mortality. Regional variations in etiology and outcomes remain underreported in central India. This study evaluated the etiological causes, Kidney Disease: Improving Global Outcomes (KDIGO) stages, clinical outcomes, and prognostic determinants of AKI in a medical intensive care unit (MICU). Materials and Methods: A prospective observational study was conducted on 120 adult patients with AKI admitted to the MICU of a tertiary care teaching hospital over 21 months (June 2024–February 2026). AKI was staged according to KDIGO criteria. Patients were monitored throughout their hospital stay and followed for 3 months to evaluate renal recovery, progression to chronic kidney disease (CKD), and in-hospital mortality. Results: Among 120 patients, 53.3% (n = 64) were male. The modal age group was 18–30 years (25.0%), followed by 31–40 and 51–60 years (17.5% each). Stage III AKI predominated at presentation (63.3%, n = 76), whereas Stage II and Stage I accounted for 31.7% (n = 38) and 5.0% (n = 6), respectively. Intrinsic renal causes constituted 59.1% (n = 71), pre-renal causes 27.5% (n = 33), and post-renal obstructive causes 13.3% (n = 16). Sepsis was the leading individual etiology (43.3%, n = 52), driven primarily by urinary tract infections (13.3%), and pneumonia (9.1%). Overall, 57.5% (n = 69) achieved complete renal recovery, 17.5% (n = 21) developed CKD (11.7% conservative, 5.8% hemodialysis-dependent), and 25.0% (n = 30) died. Pre-renal AKI showed the highest resolution rate (90.9%, n = 30/33), whereas post-renal AKI had the highest mortality (50.0%). Hypertension (P = 0.042), diabetes mellitus (P = 0.001), advancing age (P < 0.05), and requirement of renal replacement therapy (RRT; mortality 80.6%, P = 0.001) were statistically significant predictors of poor outcome. Conclusion: AKI in central Indian MICUs presents predominantly in advanced stages (Stage III), with sepsis as the leading etiology. While younger patients and pre-renal AKI demonstrate favorable recovery rates, elderly patients, pre-existing metabolic comorbidities, and the requirement for RRT independently predict adverse outcomes and high mortality.