Background: Acute kidney injury (AKI) and preexisting chronic kidney disease (CKD) are associated with unclear impact on care or treatment outcomes of critically ill patients. The occurrence of CKD is a strong risk factor for the development of AKI and subsequently high mortality rate Objectives: to evaluate patterns, clinical profile and outcomes of renal dysfunction (AKI and CKD) in patients resident in intensive care units. Methods: A multicenter retrospective descriptive comparative study using a medical records review was used to prospectively collect data. Study participants consisted of 827 adult critically ill patients during January 2012 to December 2017. Kidney function assessment is established by serum creatinine rather than direct measurement of glomerular filtration rate. Then, the assessment of CKD and severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Results: Out of 827 patients, 55% had preexisting CKD, 20.7% had AKI in 24 hrs. 15% had AKI in 48 hrs. and 7 % had AKI in 7 weeks of admission. The overall mortality rate was 87.3%. Mortality rate was the greatest in overall CKD patients (70.1%) followed by AKI without preexisting CKD (20.7%) and AKI on CKD (7.1%). Risk factors independently associated with mortality were, according to hazard ratio, APACHE-II score (0.86; 95% CI 0.83-0.88), AKI (0.67; 95% CI 0.49-0.90) (P<0.01) in patients with CKD and APACHI-II score (1.05; 95% CI 1.0-1.1) and ventilation longer duration (0.74; 95% CI 0.68-0.79) (p < 0.0001) in patients without CKD. Conclusion: Pre-ICU renal disease (CKD) significantly increases risks of death compared with patients who developed AKI and/or without renal dysfunction in intensive care units. Efforts are needed to detect patients with pre-existing renal disease, prevent the development of AKI at baseline, hasten the recovery of renal function and improve survival rate. Further studies should be conducted to confirm and extend the findings from this study, with the aim of improving clinical outcomes and reducing mortality in ICU patients with AKI.
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