Natural history and impact on outcomes of acute kidney injury in patients with road traffic injury

INTRODUCTION: The incidence and outcomes of posttraumatic acute kidney injury (AKI) have not been well-established because of the alterations in the definition used to characterize renal dysfunction. The natural history of AKI after road traffic injury (RTI) has not been studied. MATERIALS AND METHODS: We conducted a retrospective analysis of a tertiary care medical center database, on 3,945 RTI patients admitted between 2002 and 2006. RESULTS: AKI as defined by RIFLE criteria developed in 423 (10.7%) RTI patients, with maximum RIFLE class risk, injury and failure in 43.0%, 28.6%, and 28.4% respectively. A total of 59 patients (13.9% of AKI cohort) required renal replacement therapy and 77.5% of patients surviving AKI had complete renal recovery before discharge. Infusing vasopressors >= 4 h, using high-dose diuretics, and delayed transport time were identified as the independent risk factors for occurrence of AKI. Patients with maximum RIFLE class risk, injury and failure had hospital mortality rates of 37.4, 52.9 and 79.2%, respectively, compared with 7.1% for patients without AKI. RIFLE classification was also associated with the probability of making a complete renal recovery. CONCLUSIONS: Development of AKI in RTI patients represents a substantial risk for mortality in this population. Shortening the transport time and appropriate early intervention may reduce the risk of AKI. RIFLE provides a well-balanced classification system for determining AKI and predicting its outcome in this population.