Unveiling AKI at Mansoura Nephrology and Dialysis Unit: predictors of renal recovery and In-hospital mortality

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Shabaka, Ghada El-Kannishy, Eman Nagy, Mohammed Kamal Nassar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7381014/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Acute kidney injury (AKI) is a global health concern associated with high morbidity, mortality, and healthcare costs. Despite advances in prevention and management, in-hospital mortality remains significant, especially among critically ill patients. Objectives: This study assessed the incidence, risk factors, and outcomes of AKI in patients admitted to Mansoura Nephrology and Dialysis Unit (MNDU), a large tertiary renal center at Dakahlia governorate, over one year and evaluated predictors of renal recovery and in-hospital mortality. Methods: A prospective observational study was conducted from June 2022 to May 2023, including patients admitted with renal disorders. Statistical analyses identified predictors of renal recovery and mortality. Results: The study included 839 adult patients with renal disorders. Patients were classified into AKI (330, 39.3%) and non-AKI (509, 60.7%) groups. The most common AKI causes were pre-renal (54.2%), intrinsic (39.0%), and post-renal (7%). Mortality was significantly higher in the AKI group (17.3% vs. 3.8%), with septic shock as the leading cause (84.2%). Among AKI patients, 45% achieved complete recovery, 21.8% partially recovered and 33% had no recovery. At admission, younger age, female gender, and higher urine output (UOP) were associated with better renal recovery, while lower serum phosphate and higher uric acid levels predicted renal recovery and mortality, respectively. Conclusions: AKI remains among major causes of hospitalization and in-hospital mortality, with septic shock as the primary contributor. Early recognition is essential. Admission UOP and serum phosphate independently predicted renal recovery, while serum uric acid predicted mortality. These simple admission parameters may help identify high-risk patients. AKI Renal recovery In-hospital mortality Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Acute kidney injury (AKI) is a global health problem affecting both developing and developed countries leading to significant morbidity, mortality, and healthcare costs, [ 1 , 2 ]. Its rising incidence increases the risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), amplifying long-term health and economic burdens, [ 3 ]. According to KDIGO 2012 criteria, AKI is defined by a rise in serum creatinine ≥ 0.3 mg/dL within 48 hours, or to 1.5–1.99 times baseline within 7 days, or a urine output < 0.5 ml/kg/hour for more than 6–12 hours, [ 4 ]. It affects up to 22% of hospitalized patients and even higher rates, up to 67%, in ICU patients, [ 5 ]. Renal recovery is a pivotal determinant of outcomes. Early recovery is associated with reduced short- and long-term mortality, [ 6 , 7 ]. For instance, findings from the ProCESS (Protocolized Care for Early Septic Shock) trial revealed that even partial renal recovery after sepsis-induced AKI aligns one-year survival rates with those without AKI, [ 8 ]. Recovery also influences CKD risk, 21% with early reversal developed CKD within a year compared to 79% with no recovery, [ 9 ]. Long-term outcomes are shaped by multiple factors, including comorbidities, biomarkers, medication use, and post-discharge care, [ 10 ]. Despite advancements in AKI classification, prevention strategies, renal replacement therapy, and supportive care, in-hospital mortality remains alarmingly high. A significant gap in awareness persists regarding the disease and its long-term consequences especially in middle/low income countries with limited resources [ 11 , 12 ]. Patients with AKI requiring RRT face exceptionally high mortality rates, ranging from 50–80%, [ 13 ]. Key risk factors include advanced age, sepsis, disease severity, multi-organ failure, mechanical ventilation, circulatory shock, and oliguria, [ 14 ]. Additionally, multiple studies have highlighted a strong association between fluid overload and increased mortality, [ 15 , 16 ]. In developing countries, the impact of AKI is intensified by limited diagnostic resources, delayed management strategies, scarce access to RRT, and a high prevalence of sepsis, dehydration, and nephrotoxic exposures. These challenges contribute to higher morbidity, mortality, and risk of CKD progression. Despite the growing recognition of AKI as a global health concern, most existing data come from high-income countries, leaving a critical gap in understanding AKI patterns, recovery, and long-term outcomes in middle/low-income regions. This study aims to address this gap by exploring the incidence, risk factors, renal recovery, and mortality in a tertiary care center in a middle-income country. The findings will provide essential insights to inform local management strategies and contribute region-specific evidence to the global AKI literature. Patients and Methods Study design: It was a prospective observational study for one year from the beginning of June 2022 to the end of May 2023. The records of all patients with renal disorders who were admitted at Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Egypt during that period were analyzed. The study protocol was approved by the Institutional Research Board (IRB), Faculty of medicine, Mansoura University ( Code Number: MD.22.04.633 ). Inclusion and exclusion criteria: The study included patients who fulfilled the following criteria: age of 18 years or more, with renal disorders who were admitted at MNDU during the determined period. Patients of pediatric age group (< 18 years) weren’t included. Methods: All patients were subjected to: 1-Demographic and clinical data analysis including (age, gender, co-morbidities and vital parameters) 2- Laboratory assessment including routine investigations as (complete blood count (CBC), arterial blood gases (ABG), liver function tests, virology, urine analysis, serum creatinine, Serum calcium, phosphorus, intact parathormone hormone [iPTH], uric acid, CRP, LDH, lipid profile), immunological markers in certain cases as (ANA, Anti dsDNA, ANCA-P, ANCA-C, Anti GBM, APLA2R, RF, C3 andC4) in addition to plasma protein electrophoresis and Bence Jones proteins when multiple myeloma was suspected. 3-Radiological assessment Pelvi-abdominal ultrasound with full comment on both kidneys, urinary bladder, and prostate (males). Others, in certain situations if needed, as chest x-Ray, NCCT chest and brain, Spiral CT, Bone survey, and Echo. 4-Percutaneous renal biopsy if indicated in cases with unexplained AKI or CKD and persistent proteinuria or hematuria without a clear cause. It was also essential for evaluating kidney affection in systemic diseases like SLE, anti-GBM disease, or vasculitis. Patients were grouped into those with and without AKI. Outcome was assessed regarding in-hospital mortality and renal recovery. Renal recovery was assessed in patients with AKI as dialysis independency at hospital discharge especially in critically ill patients requiring dialysis, [ 17 ] and using the last available serum creatinine measurement. It was defined as complete if serum creatinine is equal to or lower than baseline or reference creatinine, and partial if it becomes lower than the creatinine at diagnosis but not down to baseline or reference. On the other hand, no-recovery was considered if the serum creatinine did not improve or if the patient discharged on dialysis [ 18 , 19 ]. Statistical analysis: The collected data was coded, processed & analyzed using the Statistical Package for Social Science (SPSS) version 25 for Windows on personal computers. Qualitative information was described as percentage and numbers. While quantitative information will be described as means [± standard deviation (SD)] for parametric variables or medians (minimum and maximum), for non-parametric variables, as suitable. To assess the normality of distribution of variables, Shapiro-Wilk test was used. For comparing between groups, the t-test was used for normally distributed variables and Mann Whitney test for non-normally distributed variables. The Chi-square test was used for comparing between qualitative variables. Parametric correlations were analyzed using Pearson’s correlation, while non-parametric correlations and correlation with categorical variables were analyzed by Spearman’s rank correlation. The level of significance was considered at 5% (P ≤ 0.05). Logistic regression analysis was performed to define predictors of mortality and recovery. Results The current study included 839 cases admitted with different renal disorders, 330(39.3%) cases with AKI and 509(60.7%) without AKI. AKI group were older (median age of 60 years), with a nearly equal distribution between females (51.5%) and males (48.5%). A significant proportion had pre-existing HTN (55.8%) and DM (37.3%), while 30.3% had a history of pre-existing CKD. Non-AKI group exhibited lower comorbidities (DM, cardiac diseases and advanced liver cirrhosis) and risk factors associated with AKI. Laboratory data illustrated also significant differences between both groups. While WBC count, HB and serum calcium levels were significantly higher among AKI-group, serum creatinine, 24-hour urinary protein and serum iPTH levels were significantly lower among them, (Table 1). The most common causes of AKI were pre-renal followed by intrinsic and post-renal causes (54.2%, 39.0% and 7% respectively) (Figure I) . Sepsis, hypovolemia and hemodynamic effects of some drugs as NSAIDS and ACEIs/ARBs were the most common causes of pre-renal AKI (54.2%, 38.5% and 34.5% respectively). Interstitial nephritis, mostly due to acute pyelonephritis, was the most common cause of intrinsic-renal AKI, followed by acute tubular injury and small vessel vascular diseases (54.6%, 22.8% and 9.4% respectively). Post renal AKI represented only 7% of AKI causes. Unfortunately, in-hospital mortality was recorded in 17.3% of patients with AKI during admission, predominantly due to septic shock (84.2%). It was higher among AKI-group (17.3% vs 3.8%). While 45% of patients with AKI achieved complete recovery, 21.8% achieved partial recovery and about 33% did not recover at discharge, (Table 2) . Patients who achieved complete or partial recovery were younger than those who didn’t recover ( median ages were 59 and 63 years respectively). Females exhibited higher recovery rates. Patients who didn’t recover had lower amounts of UOP at admission. Platelet count, serum Na and albumin levels were significantly lower in non-recovery group while serum creatinine, PO4, uric acid levels and INR were significantly higher among non-recovery group. Non-survivors were older and mostly males. They experienced higher duration of HTN and mostly had comorbidities as CKD, cardiac diseases and liver failure. They had significantly higher serum K, CRP, creatinine, PO4, uric acid and liver function levels (Table 3 ). Univariate regression analysis revealed that age, female gender, amount of UOP, serum Na, creatinine, albumin, PO4 and uric acid levels at admission were significant predictors of recovery. However, on multiple regression analysis, only amount of UOP (OR = 1.001, P < 0.010) and serum PO4 (OR = 0.610, P = 0.030) were significant predictors of recovery. Age, female gender, advanced liver cirrhosis, systolic BP, amount of UOP, serum CRP and uric acid levels at admission were significant predictors of mortality on univariate regression analysis. Serum uric acid level at admission was the only significant predictor of mortality on multivariate regression analysis. The previous variables affecting mortality were selected based on highest P-value levels, (Table 4) . ROC curves illustrated that the value of 425 ml for UOP and 5.35 mg/dL for serum PO4 were the best values associated with renal recovery (sensitivity = 73% and 75%, specificity = 62% and 59% respectively), Figures (II and III), Tables (5 and 6). It also illustrated that the value of 8.15mg/dL for serum uric acid at admission was the best value associated with mortality after AKI (sensitivity = 91% and specificity = 47%), Figure (IV), Table (7). Discussion In the current study, we unveiled AKI short-term impacts among patients admitted at MNDU during a one-year period. Results revealed high incidence of AKI as a cause for admission. It represented 39.3% (48.5% males and 51.5% females), mostly of old age. Comorbidities and risk factors exhibited significant association with AKI. Ikizler et al reported similar results except higher AKI incidence among males, [ 20 ]. Aging kidneys undergo structural and hemodynamic changes that hinder autoregulatory capacity resulting in increased susceptibility to AKI in elderly, [ 21 ]. Structural changes include progressive glomerular and vascular sclerosis, decreasing weight and tubular atrophy with interstitial fibrosis, [ 22 ]. While functional changes include decreased renal sensitivity to vasomotor mediators, increased intra-glomerular pressure, decreased eGFR and ultrafiltration co-efficient [ 23 ]. Pre-existing CKD and multiple co-morbidities also have a negative impact on the structural and functional capacity of the kidneys. Pre-renal AKI was the most prevalent pathophysiological cause of AKI followed by intrinsic and post-renal causes. Risk factors associated with pre-renal AKI were sepsis, hypovolemia and hemodynamic effects of commonly used drugs as ACEIs, ARBs and NSAIDs. Intrinsic-renal AKI was a complication of acute pyelonephritis, followed by acute tubular injury and acute glomerulonephritis. Post renal causes were rare as they were referred mainly to urology department. Wang and colleagues reported similar results, but they illustrated that kidney hypoperfusion and nephrotoxic drugs were the most common insults of pre-renal AKI (74.7% and 59.9% respectively). Sepsis represented only 5.7% while environmental or other toxins were rare, [ 24 ]. The high incidence of sepsis and hence sepsis induced AKI in Egypt and generally low economy, developing countries remains one of the major challenges we face with a large burden on the healthcare system and economy. Moreover, cases of severe sepsis are expected to rise in the future for several reasons which include increasing awareness and sensitivity for the diagnosis, increasing numbers of immunocompromised patients, wider use of invasive procedures, more resistant microorganisms, and old aging population, [ 25 ]. Surveillance, good sanitation, regular monitoring and health campaigns must strongly stand up facing this monster. Complete renal recovery was achieved in about 45% of our patients while 21.8% and 33.0% experienced partial and no recovery respectively. Kaaviya and colleagues reported 45% complete renal recovery, 47.4% partial renal recovery and 7.6% no recovery, [ 26 ]. In another study conducted by Kaul et al., complete recovery was reported in 44% while partial recovery was reported in 13%, [ 27 ]. Diverse recovery rates may be attributed to different inclusion and population criteria as well as different geographical regions and healthcare facilities. In the present study, men and elderly were less likely to recover compared to women and younger ones. Decompensated liver cirrhosis was also a risk factor for non-recovery in addition to the severity of AKI at admission as determined by lower amount of UOP and higher serum creatinine levels. Lower platelet count, higher INR, hyperkalemia, hyperphosphatemia and lower serum albumin levels ,which might be evident during severe acute inflammatory conditions and high catabolic state, were also associated with lower recovery rates. Sex differences in AKI incidence, severity, and progression continue to be identified. Generally, women are protected from AKI when compared to men. Much of the protection exhibited in women is diminished after menopause. Gonadal hormones have been offered as a main contributor to this gender and age effect. Different studies illustrated that estrogen and testosterone seem to modulate susceptibility to AKI by various cellular and molecular pathways, [ 28 ]. A large cohort using USRDS, [ 29 ] and another one by Foley and his colleagues, [ 30 ] illustrated the same results regarding age but different results regarding gender. Xiong and his colleagues reported also higher AKI episodes among hospitalized advanced chronic liver disease patients with lower recovery rates, mostly due to compromised renal perfusion in advanced liver cirrhosis [ 31 ]. Several studies showed that patients with normal baseline kidney function would achieve recovery more than patients with pre-existing CKD, [ 32 – 34 ]. Others illustrated the risk of prior AKI episodes, [ 35 ], presence of DM, [ 36 ] and CVD, [ 37 ] on renal recovery and outcome. In the current study, in-hospital mortality among patients with AKI represented 57/330 (17.3%), with sepsis as the most common cause of death. In concordance with our results, Kaaviya and colleagues reported mortality rate of about 15%, mostly due to snake-bite related AKI followed by sepsis associated with acute pyelonephritis, [ 38 ]. Other studies reported different mortality rates among patients with AKI ranging from 22% in Najeeb et al. [ 39 ] to 37% in a national analysis study for community acquired AKI in UK, [ 40 ]. The differences between these results may be due to different inclusion and population criteria as well as different geographical regions and health care systems. In-hospital mortality associated with AKI was higher among males and elderly. It was also allied to multiple comorbidities as cardio-vascular disease, liver failure, pre-existing CKD and prolonged HTN. Clinical parameters at admission signified mortality as UOP, systolic and diastolic BP values. Higher serum creatinine, K, PO4, CRP and uric acid levels were associated with mortality in addition to lower platelet count and serum Na. In a large French database analysis, mortality was higher among hospitalized males and elderly patients with severe AKI, [ 41 ]. Kohle et al., also reported similar results, [ 42 ]. Several studies tried to find applicable tools using different laboratory parameters for prediction of the probability of renal recovery and survival among patients with AKI but without validation of any tool yet. We found that increased serum uric acid is a significant predictor of mortality while increased amount of UOP and decreased serum PO4 at admission are significant predictors of renal recovery. Lee and colleagues developed a four-variable prediction model for recovery including age, chronic liver disease, pre-admission HB level and eGFR, [ 43 ]. Predictors of mortality after AKI varied widely among different studies. Saly and colleagues found that increased serum anion gap, hypomagnesemia and hyperkalemia were strong predictors of mortality. Pre-operative albuminuria was also found to be predictor of AKI, AKI requiring dialysis and mortality in patients undergoing cardiac surgery, [ 44 ]. Conclusion This study highlights the significant burden of AKI among hospitalized patients with renal disorders, revealing a high incidence of AKI, variable recovery outcomes, and notable in-hospital mortality. Pre-renal causes, particularly sepsis and hypovolemia, were predominant contributors to AKI. Serum uric acid emerged as a significant predictor of mortality, while urine output and serum phosphate levels were valuable indicators of renal recovery. Strengths of this study include its prospective design, comprehensive clinical and laboratory evaluation, and the use of multiple regression analyses to identify independent predictors. However, the study has some limitations. Being a single-center study may limit the generalizability of the findings to other settings. Additionally, follow-up data after hospital discharge were not available, which restricted the assessment of long-term outcomes. Despite these limitations, the findings underscore the need for early risk stratification and targeted management strategies to improve outcomes in patients with AKI. Declarations Conflict of interests: The authors declared that they have no conflict of interest. Disclosure: Ethics approval and consent to participate : The Institutional Review Board (IRB) and Ethical Committee of Mansoura Faculty of Medicine approved the protocol of this research ( Approval Code Number: MD.22.04.633 ). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). Written informed consent was obtained from all participants before inclusion. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Shimaa A. Shabaka: Conceptualization, data collection, formal analysis, writing—original draft preparation.Ghada El-Kannishy: Supervision, validation, writing, review and editing.Eman Nagy: Data collection, writing, review and editing.Mohammed Kamal Nassar: Methodology, data interpretation, writing, review and editing.All authors read and approved the final manuscript. Data Availability The Institutional Review Board (IRB) and Ethical Committee of Mansoura Faculty of Medicine approved the protocol of this research (Approval Code Number: MD.22.04.633). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). Written informed consent was obtained from all participants before inclusion.Data availability: All data generated or analyzed during this study are included in this published article. References Hoste EA et al. Global epidemiology and outcomes of acute kidney injury. 2018. 14(10): pp. 607–25. Lameire NH, et al. 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Lee BJ et al. Predicting renal recovery after dialysis-requiring acute kidney injury. 2019. 4(4): pp. 571–581. Saly D et al. Approaches to predicting outcomes in patients with acute kidney injury. 2017. 12(1): p. e0169305. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 20 Sep, 2025 Reviews received at journal 18 Sep, 2025 Reviewers agreed at journal 12 Sep, 2025 Reviewers invited by journal 11 Sep, 2025 Editor invited by journal 22 Aug, 2025 Editor assigned by journal 19 Aug, 2025 Submission checks completed at journal 19 Aug, 2025 First submitted to journal 15 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":79217,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClassification of AKI between studied cases.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7381014/v1/dacfb59b5d4e83327f788cc6.png"},{"id":91834862,"identity":"08520f50-681e-42ed-96e6-9a038dc86dd6","added_by":"auto","created_at":"2025-09-22 09:27:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24787,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eUOP at admission as a predictor of renal recovery\u003c/strong\u003e.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7381014/v1/10fa33bf365f93db45b498b7.png"},{"id":91834864,"identity":"26ff88e4-91a0-49bb-a56f-3f1d1dfccb72","added_by":"auto","created_at":"2025-09-22 09:27:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24681,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSerum phosphorus at admission as a predictor of renal recovery.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7381014/v1/75c4136f2a8c80400b98d488.png"},{"id":91834865,"identity":"b24847ab-afed-42e9-ab6f-7ab8da25d707","added_by":"auto","created_at":"2025-09-22 09:27:50","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24717,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSerum uric acid at admission as a predictor of in-hospital mortality of patients with AKI.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7381014/v1/d58fa267fc36a053a73cd1f7.png"},{"id":91838386,"identity":"37080e3f-4d0e-4222-87a0-7357462a5c35","added_by":"auto","created_at":"2025-09-22 09:43:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":831500,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7381014/v1/d882724a-03c8-4157-9117-159390a347c7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unveiling AKI at Mansoura Nephrology and Dialysis Unit: predictors of renal recovery and In-hospital mortality","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute kidney injury (AKI) is a global health problem affecting both developing and developed countries leading to significant morbidity, mortality, and healthcare costs, [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Its rising incidence increases the risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), amplifying long-term health and economic burdens, [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to KDIGO 2012 criteria, AKI is defined by a rise in serum creatinine\u0026thinsp;\u0026ge;\u0026thinsp;0.3 mg/dL within 48 hours, or to 1.5\u0026ndash;1.99 times baseline within 7 days, or a urine output\u0026thinsp;\u0026lt;\u0026thinsp;0.5 ml/kg/hour for more than 6\u0026ndash;12 hours, [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It affects up to 22% of hospitalized patients and even higher rates, up to 67%, in ICU patients, [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRenal recovery is a pivotal determinant of outcomes. Early recovery is associated with reduced short- and long-term mortality, [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For instance, findings from the ProCESS (Protocolized Care for Early Septic Shock) trial revealed that even partial renal recovery after sepsis-induced AKI aligns one-year survival rates with those without AKI, [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Recovery also influences CKD risk, 21% with early reversal developed CKD within a year compared to 79% with no recovery, [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Long-term outcomes are shaped by multiple factors, including comorbidities, biomarkers, medication use, and post-discharge care, [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite advancements in AKI classification, prevention strategies, renal replacement therapy, and supportive care, in-hospital mortality remains alarmingly high. A significant gap in awareness persists regarding the disease and its long-term consequences especially in middle/low income countries with limited resources [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Patients with AKI requiring RRT face exceptionally high mortality rates, ranging from 50\u0026ndash;80%, [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Key risk factors include advanced age, sepsis, disease severity, multi-organ failure, mechanical ventilation, circulatory shock, and oliguria, [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, multiple studies have highlighted a strong association between fluid overload and increased mortality, [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn developing countries, the impact of AKI is intensified by limited diagnostic resources, delayed management strategies, scarce access to RRT, and a high prevalence of sepsis, dehydration, and nephrotoxic exposures. These challenges contribute to higher morbidity, mortality, and risk of CKD progression. Despite the growing recognition of AKI as a global health concern, most existing data come from high-income countries, leaving a critical gap in understanding AKI patterns, recovery, and long-term outcomes in middle/low-income regions. This study aims to address this gap by exploring the incidence, risk factors, renal recovery, and mortality in a tertiary care center in a middle-income country. The findings will provide essential insights to inform local management strategies and contribute region-specific evidence to the global AKI literature.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design:\u003c/h2\u003e\u003cp\u003eIt was a prospective observational study for one year from the beginning of June 2022 to the end of May 2023. The records of all patients with renal disorders who were admitted at Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Egypt during that period were analyzed.\u003c/p\u003e\u003cp\u003eThe study protocol was approved by the Institutional Research Board (IRB), Faculty of medicine, Mansoura University (\u003cb\u003eCode Number: MD.22.04.633\u003c/b\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria:\u003c/h3\u003e\n\u003cp\u003eThe study included patients who fulfilled the following criteria: age of 18 years or more, with renal disorders who were admitted at MNDU during the determined period. Patients of pediatric age group (\u0026lt;\u0026thinsp;18 years) weren\u0026rsquo;t included.\u003c/p\u003e\n\u003ch3\u003eMethods:\u003c/h3\u003e\n\u003cp\u003eAll patients were subjected to:\u003c/p\u003e\u003cp\u003e\u003cb\u003e1-Demographic and clinical data analysis\u003c/b\u003e including (age, gender, co-morbidities and vital parameters)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e2- Laboratory assessment\u003c/strong\u003e\u003cp\u003eincluding routine investigations as (complete blood count (CBC), arterial blood gases (ABG), liver function tests, virology, urine analysis, serum creatinine, Serum calcium, phosphorus, intact parathormone hormone [iPTH], uric acid, CRP, LDH, lipid profile), immunological markers in certain cases as (ANA, Anti dsDNA, ANCA-P, ANCA-C, Anti GBM, APLA2R, RF, C3 andC4) in addition to plasma protein electrophoresis and Bence Jones proteins when multiple myeloma was suspected.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3-Radiological assessment\u003c/strong\u003e\u003cp\u003ePelvi-abdominal ultrasound with full comment on both kidneys, urinary bladder, and prostate (males). Others, in certain situations if needed, as chest x-Ray, NCCT chest and brain, Spiral CT, Bone survey, and Echo.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e4-Percutaneous renal biopsy if indicated\u003c/strong\u003e\u003cp\u003ein cases with unexplained AKI or CKD and persistent proteinuria or hematuria without a clear cause. It was also essential for evaluating kidney affection in systemic diseases like SLE, anti-GBM disease, or vasculitis.\u003c/p\u003e\u003c/p\u003e\u003cp\u003ePatients were grouped into those with and without AKI. Outcome was assessed regarding in-hospital mortality and renal recovery. Renal recovery was assessed in patients with AKI as dialysis independency at hospital discharge especially in critically ill patients requiring dialysis, [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and using the last available serum creatinine measurement. It was defined as complete if serum creatinine is equal to or lower than baseline or reference creatinine, and partial if it becomes lower than the creatinine at diagnosis but not down to baseline or reference. On the other hand, no-recovery was considered if the serum creatinine did not improve or if the patient discharged on dialysis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eThe collected data was coded, processed \u0026amp; analyzed using the Statistical Package for Social Science (SPSS) version 25 for Windows on personal computers. Qualitative information was described as percentage and numbers. While quantitative information will be described as means [\u0026plusmn;\u0026thinsp;standard deviation (SD)] for parametric variables or medians (minimum and maximum), for non-parametric variables, as suitable. To assess the normality of distribution of variables, Shapiro-Wilk test was used. For comparing between groups, the t-test was used for normally distributed variables and Mann Whitney test for non-normally distributed variables. The Chi-square test was used for comparing between qualitative variables. Parametric correlations were analyzed using Pearson\u0026rsquo;s correlation, while non-parametric correlations and correlation with categorical variables were analyzed by Spearman\u0026rsquo;s rank correlation. The level of significance was considered at 5% (P\u0026thinsp;\u0026le;\u0026thinsp;0.05). Logistic regression analysis was performed to define predictors of mortality and recovery.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe current study included 839 cases admitted with different renal disorders, 330(39.3%) cases with AKI and 509(60.7%) without AKI. AKI group were older (median age of 60 years), with a nearly equal distribution between females (51.5%) and males (48.5%). A significant proportion had pre-existing HTN (55.8%) and DM (37.3%), while 30.3% had a history of pre-existing CKD. Non-AKI group exhibited lower comorbidities (DM, cardiac diseases and advanced liver cirrhosis) and risk factors associated with AKI. Laboratory data illustrated also significant differences between both groups. While WBC count, HB and serum calcium levels were significantly higher among AKI-group, serum creatinine, 24-hour urinary protein and serum iPTH levels were significantly lower among them, \u003cb\u003e(Table\u0026nbsp;1).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe most common causes of AKI were pre-renal followed by intrinsic and post-renal causes (54.2%, 39.0% and 7% respectively) \u003cb\u003e(Figure I)\u003c/b\u003e. Sepsis, hypovolemia and hemodynamic effects of some drugs as NSAIDS and ACEIs/ARBs were the most common causes of pre-renal AKI (54.2%, 38.5% and 34.5% respectively). Interstitial nephritis, mostly due to acute pyelonephritis, was the most common cause of intrinsic-renal AKI, followed by acute tubular injury and small vessel vascular diseases (54.6%, 22.8% and 9.4% respectively). Post renal AKI represented only 7% of AKI causes.\u003c/p\u003e\u003cp\u003eUnfortunately, in-hospital mortality was recorded in 17.3% of patients with AKI during admission, predominantly due to septic shock (84.2%). It was higher among AKI-group (17.3% vs 3.8%). While 45% of patients with AKI achieved complete recovery, 21.8% achieved partial recovery and about 33% did not recover at discharge, \u003cb\u003e(Table\u0026nbsp;2)\u003c/b\u003e. Patients who achieved complete or partial recovery were younger than those who didn\u0026rsquo;t recover \u003cb\u003e(\u003c/b\u003emedian ages were 59 and 63 years respectively). Females exhibited higher recovery rates. Patients who didn\u0026rsquo;t recover had lower amounts of UOP at admission. Platelet count, serum Na and albumin levels were significantly lower in non-recovery group while serum creatinine, PO4, uric acid levels and INR were significantly higher among non-recovery group. Non-survivors were older and mostly males. They experienced higher duration of HTN and mostly had comorbidities as CKD, cardiac diseases and liver failure. They had significantly higher serum K, CRP, creatinine, PO4, uric acid and liver function levels \u003cb\u003e(Table\u0026nbsp;3\u003c/b\u003e).\u003c/p\u003e\u003cp\u003eUnivariate regression analysis revealed that age, female gender, amount of UOP, serum Na, creatinine, albumin, PO4 and uric acid levels at admission were significant predictors of recovery. However, on multiple regression analysis, only amount of UOP (OR\u0026thinsp;=\u0026thinsp;1.001, P\u0026thinsp;\u0026lt;\u0026thinsp;0.010) and serum PO4 (OR\u0026thinsp;=\u0026thinsp;0.610, P\u0026thinsp;=\u0026thinsp;0.030) were significant predictors of recovery. Age, female gender, advanced liver cirrhosis, systolic BP, amount of UOP, serum CRP and uric acid levels at admission were significant predictors of mortality on univariate regression analysis. Serum uric acid level at admission was the only significant predictor of mortality on multivariate regression analysis. The previous variables affecting mortality were selected based on highest P-value levels, \u003cb\u003e(Table\u0026nbsp;4)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eROC curves illustrated that the value of 425 ml for UOP and 5.35 mg/dL for serum PO4 were the best values associated with renal recovery (sensitivity\u0026thinsp;=\u0026thinsp;73% and 75%, specificity\u0026thinsp;=\u0026thinsp;62% and 59% respectively), \u003cb\u003eFigures (II and III), Tables\u0026nbsp;(5 and 6).\u003c/b\u003e It also illustrated that the value of 8.15mg/dL for serum uric acid at admission was the best value associated with mortality after AKI (sensitivity\u0026thinsp;=\u0026thinsp;91% and specificity\u0026thinsp;=\u0026thinsp;47%), \u003cb\u003eFigure (IV), Table\u0026nbsp;(7).\u003c/b\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the current study, we unveiled AKI short-term impacts among patients admitted at MNDU during a one-year period. Results revealed high incidence of AKI as a cause for admission. It represented 39.3% (48.5% males and 51.5% females), mostly of old age. Comorbidities and risk factors exhibited significant association with AKI. Ikizler et al reported similar results except higher AKI incidence among males, [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Aging kidneys undergo structural and hemodynamic changes that hinder autoregulatory capacity resulting in increased susceptibility to AKI in elderly, [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Structural changes include progressive glomerular and vascular sclerosis, decreasing weight and tubular atrophy with interstitial fibrosis, [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. While functional changes include decreased renal sensitivity to vasomotor mediators, increased intra-glomerular pressure, decreased eGFR and ultrafiltration co-efficient [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Pre-existing CKD and multiple co-morbidities also have a negative impact on the structural and functional capacity of the kidneys.\u003c/p\u003e\u003cp\u003ePre-renal AKI was the most prevalent pathophysiological cause of AKI followed by intrinsic and post-renal causes. Risk factors associated with pre-renal AKI were sepsis, hypovolemia and hemodynamic effects of commonly used drugs as ACEIs, ARBs and NSAIDs. Intrinsic-renal AKI was a complication of acute pyelonephritis, followed by acute tubular injury and acute glomerulonephritis. Post renal causes were rare as they were referred mainly to urology department. Wang and colleagues reported similar results, but they illustrated that kidney hypoperfusion and nephrotoxic drugs were the most common insults of pre-renal AKI (74.7% and 59.9% respectively). Sepsis represented only 5.7% while environmental or other toxins were rare, [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The high incidence of sepsis and hence sepsis induced AKI in Egypt and generally low economy, developing countries remains one of the major challenges we face with a large burden on the healthcare system and economy. Moreover, cases of severe sepsis are expected to rise in the future for several reasons which include increasing awareness and sensitivity for the diagnosis, increasing numbers of immunocompromised patients, wider use of invasive procedures, more resistant microorganisms, and old aging population, [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Surveillance, good sanitation, regular monitoring and health campaigns must strongly stand up facing this monster.\u003c/p\u003e\u003cp\u003eComplete renal recovery was achieved in about 45% of our patients while 21.8% and 33.0% experienced partial and no recovery respectively. Kaaviya and colleagues reported 45% complete renal recovery, 47.4% partial renal recovery and 7.6% no recovery, [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In another study conducted by Kaul et al., complete recovery was reported in 44% while partial recovery was reported in 13%, [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Diverse recovery rates may be attributed to different inclusion and population criteria as well as different geographical regions and healthcare facilities.\u003c/p\u003e\u003cp\u003eIn the present study, men and elderly were less likely to recover compared to women and younger ones. Decompensated liver cirrhosis was also a risk factor for non-recovery in addition to the severity of AKI at admission as determined by lower amount of UOP and higher serum creatinine levels. Lower platelet count, higher INR, hyperkalemia, hyperphosphatemia and lower serum albumin levels ,which might be evident during severe acute inflammatory conditions and high catabolic state, were also associated with lower recovery rates.\u003c/p\u003e\u003cp\u003eSex differences in AKI incidence, severity, and progression continue to be identified. Generally, women are protected from AKI when compared to men. Much of the protection exhibited in women is diminished after menopause. Gonadal hormones have been offered as a main contributor to this gender and age effect. Different studies illustrated that estrogen and testosterone seem to modulate susceptibility to AKI by various cellular and molecular pathways, [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA large cohort using USRDS, [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and another one by Foley and his colleagues, [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] illustrated the same results regarding age but different results regarding gender. \u003cb\u003eXiong and his colleagues\u003c/b\u003e reported also higher AKI episodes among hospitalized advanced chronic liver disease patients with lower recovery rates, mostly due to compromised renal perfusion in advanced liver cirrhosis [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral studies showed that patients with normal baseline kidney function would achieve recovery more than patients with pre-existing CKD, [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Others illustrated the risk of prior AKI episodes, [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], presence of DM, [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and CVD, [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] on renal recovery and outcome.\u003c/p\u003e\u003cp\u003eIn the current study, in-hospital mortality among patients with AKI represented 57/330 (17.3%), with sepsis as the most common cause of death. In concordance with our results, \u003cb\u003eKaaviya and colleagues\u003c/b\u003e reported mortality rate of about 15%, mostly due to snake-bite related AKI followed by sepsis associated with acute pyelonephritis, [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Other studies reported different mortality rates among patients with AKI ranging from 22% in Najeeb et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] to 37% in a national analysis study for community acquired AKI in UK, [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The differences between these results may be due to different inclusion and population criteria as well as different geographical regions and health care systems.\u003c/p\u003e\u003cp\u003eIn-hospital mortality associated with AKI was higher among males and elderly. It was also allied to multiple comorbidities as cardio-vascular disease, liver failure, pre-existing CKD and prolonged HTN. Clinical parameters at admission signified mortality as UOP, systolic and diastolic BP values. Higher serum creatinine, K, PO4, CRP and uric acid levels were associated with mortality in addition to lower platelet count and serum Na. In a large French database analysis, mortality was higher among hospitalized males and elderly patients with severe AKI, [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Kohle et al., also reported similar results, [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral studies tried to find applicable tools using different laboratory parameters for prediction of the probability of renal recovery and survival among patients with AKI but without validation of any tool yet. We found that increased serum uric acid is a significant predictor of mortality while increased amount of UOP and decreased serum PO4 at admission are significant predictors of renal recovery. Lee and colleagues developed a four-variable prediction model for recovery including age, chronic liver disease, pre-admission HB level and eGFR, [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Predictors of mortality after AKI varied widely among different studies. Saly and colleagues found that increased serum anion gap, hypomagnesemia and hyperkalemia were strong predictors of mortality. Pre-operative albuminuria was also found to be predictor of AKI, AKI requiring dialysis and mortality in patients undergoing cardiac surgery, [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the significant burden of AKI among hospitalized patients with renal disorders, revealing a high incidence of AKI, variable recovery outcomes, and notable in-hospital mortality. Pre-renal causes, particularly sepsis and hypovolemia, were predominant contributors to AKI. Serum uric acid emerged as a significant predictor of mortality, while urine output and serum phosphate levels were valuable indicators of renal recovery. Strengths of this study include its prospective design, comprehensive clinical and laboratory evaluation, and the use of multiple regression analyses to identify independent predictors. However, the study has some limitations. Being a single-center study may limit the generalizability of the findings to other settings. Additionally, follow-up data after hospital discharge were not available, which restricted the assessment of long-term outcomes. Despite these limitations, the findings underscore the need for early risk stratification and targeted management strategies to improve outcomes in patients with AKI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interests:\u003c/h2\u003e\n\u003cp\u003eThe authors declared that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: The Institutional Review Board (IRB) and Ethical Committee of Mansoura Faculty of Medicine approved the protocol of this research (\u003cstrong\u003eApproval Code Number: MD.22.04.633\u003c/strong\u003e). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). Written informed consent was obtained from all participants before inclusion.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;\u003c/h2\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eShimaa A. Shabaka: Conceptualization, data collection, formal analysis, writing\u0026mdash;original draft preparation.Ghada El-Kannishy: Supervision, validation, writing, review and editing.Eman Nagy: Data collection, writing, review and editing.Mohammed Kamal Nassar: Methodology, data interpretation, writing, review and editing.All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe Institutional Review Board (IRB) and Ethical Committee of Mansoura Faculty of Medicine approved the protocol of this research (Approval Code Number: MD.22.04.633). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). Written informed consent was obtained from all participants before inclusion.Data availability: All data generated or analyzed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHoste EA et al. Global epidemiology and outcomes of acute kidney injury. 2018. 14(10): pp. 607\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLameire NH, et al. Acute kidney injury: increasing global concern. 2013;382(9887):170\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMehta RL et al. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. 2015. 385(9987): pp. 2616\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhwaja AJNCP. \u003cem\u003eKDIGO clinical practice guidelines for acute kidney injury.\u003c/em\u003e 2012. 120(4): pp. c179-c184.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKellum JA, Lameire N, K.A.G.W.G.J C, care. \u003cem\u003eDiagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1).\u003c/em\u003e 2013. 17: pp. 1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeerapornratana S et al. \u003cem\u003eRecovery after AKI: effects on outcomes over 15 years.\u003c/em\u003e 2023. 76: p. 154280.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSood MM et al. Early reversible acute kidney injury is associated with improved survival in septic shock. 2014. 29(5): pp. 711\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKellum JA, et al. The effects of alternative resuscitation strategies on acute kidney injury. patients septic shock. 2016;193(3):281\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChua H-R et al. Extended mortality and chronic kidney disease after septic acute kidney injury. 2020. 35(6): pp. 527\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdel-Rahman EM et al. Determinants of outcomes of acute kidney injury: clinical predictors and beyond. 2021. 10(6): p. 1175.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSelby NM, et al. Int criteria acute kidney injury: advantages remaining challenges. 2016;13(9):e1002122.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbd ElHafeez S, et al. 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Fluid balance in sepsis and septic shock as a determining factor of mortality. 2015. 33(2): pp. 186\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMacedo E, Bouchard J. L.J.C.o.i.c.c. Mehta. Ren recovery following acute kidney injury. 2008;14(6):660\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMehta RL, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet. 2016;387(10032):2017\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeung M, et al. Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury. Nephrol Dialysis Transplantation. 2012;27(3):956\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIkizler TA et al. A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death. 2021. 99(2): pp. 456\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHill GS, Heudes D, Bari\u0026eacute;ty JJKi. Morphometric study arterioles glomeruli aging kidney suggests focal loss autoregulation. 2003;63(3):1027\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFuiano G et al. Renal hemodynamic response to maximal vasodilating stimulus in healthy older subjects. 2001. 59(3): pp. 1052\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoang K, et al. Determinants glomerular hypofiltration aging Hum. 2003;64(4):1417\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Y, et al. Community-acquired acute kidney injury: a. nationwide Surv China. 2017;69(5):647\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSinger M et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). 2016. 315(8): pp. 801\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaaviya R, et al. Community Acquired AKI: A Prospective Observational Study from a Tertiary Level Hospital in Southern India. Indian J Nephrol. 2019;29(4):254\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKellum JA et al. \u003cem\u003eKidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury.\u003c/em\u003e 2012. 2(1): pp. 1-138.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurtis LM. \u003cem\u003eSex and Gender Differences in AKI.\u003c/em\u003e 2024. 5(1): pp. 160\u0026ndash;167.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah S et al. Mortality and recovery associated with kidney failure due to acute kidney injury. 2020. 15(7): p. 995.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFoley RN et al. \u003cem\u003eEnd-stage renal disease attributed to acute tubular necrosis in the United States, 2001\u0026ndash;2010.\u003c/em\u003e 2015. 41(1): pp. 1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiong J et al. Evaluation of the criteria of hepatorenal syndrome type of acute kidney injury in patients with cirrhosis admitted to ICU. 2018. 53(12): pp. 1590\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUchino S et al. Acute renal failure in critically ill patients: a multinational, multicenter study. 2005. 294(7): pp. 813\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchiffl HJNDT. Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. 2006. 21(5): pp. 1248\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez Sanchidri\u0026aacute;n S et al. Survival and renal recovery after acute kidney injury requiring dialysis outside of intensive care units. 2020. 52: pp. 2367\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGautam SC et al. Predictors and outcomes of post-hospitalization dialysis dependent acute kidney injury. 2015. 131(3): pp. 185\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHapca S et al. The relationship between AKI and CKD in patients with type 2 diabetes: an observational cohort study. 2021. 32(1): p. 138.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJames MT et al. A meta-analysis of the association of estimated GFR, albuminuria, diabetes mellitus, and hypertension with acute kidney injury. 2015. 66(4): pp. 602\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaaviya R et al. Community acquired AKI: a prospective observational study from a tertiary level hospital in Southern India. 2019. 29(4): pp. 254\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNajeeb Q, Aziz R, J.I.J.O.S S. Community-acquired acute kidney injury in a tertiary care hospital: a cross-sectional study. 2015. 3(1): pp. 58\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli T et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. 2007. 18(4): pp. 1292\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarnier F, et al. Increased incidence acute kidney injury requiring dialysis metropolitan France. 2019;14(2):e0211541.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKolhe NV et al. \u003cem\u003eCase mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme database.\u003c/em\u003e 2008. 12: pp. 1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee BJ et al. \u003cem\u003ePredicting renal recovery after dialysis-requiring acute kidney injury.\u003c/em\u003e 2019. 4(4): pp. 571\u0026ndash;581.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaly D et al. Approaches to predicting outcomes in patients with acute kidney injury. 2017. 12(1): p. e0169305.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"AKI, Renal recovery, In-hospital mortality","lastPublishedDoi":"10.21203/rs.3.rs-7381014/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7381014/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAcute kidney injury (AKI) is a global health concern associated with high morbidity, mortality, and healthcare costs. Despite advances in prevention and management, in-hospital mortality remains significant, especially among critically ill patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e This study assessed the incidence, risk factors, and outcomes of AKI in patients admitted to Mansoura Nephrology and Dialysis Unit (MNDU), a large tertiary renal center at Dakahlia governorate, over one year and evaluated predictors of renal recovery and in-hospital mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A prospective observational study was conducted from June 2022 to May 2023, including patients admitted with renal disorders. Statistical analyses identified predictors of renal recovery and mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study included 839 adult patients with renal disorders. Patients were classified into AKI (330, 39.3%) and non-AKI (509, 60.7%) groups. The most common AKI causes were pre-renal (54.2%), intrinsic (39.0%), and post-renal (7%). Mortality was significantly higher in the AKI group (17.3% vs. 3.8%), with septic shock as the leading cause (84.2%). Among AKI patients, 45% achieved complete recovery, 21.8% partially recovered and 33% had no recovery. At admission, younger age, female gender, and higher urine output (UOP) were associated with better renal recovery, while lower serum phosphate and higher uric acid levels predicted renal recovery and mortality, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e AKI remains among major causes of hospitalization and in-hospital mortality, with septic shock as the primary contributor. Early recognition is essential. Admission UOP and serum phosphate independently predicted renal recovery, while serum uric acid predicted mortality. These simple admission parameters may help identify high-risk patients.\u003c/p\u003e","manuscriptTitle":"Unveiling AKI at Mansoura Nephrology and Dialysis Unit: predictors of renal recovery and In-hospital mortality","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 09:27:46","doi":"10.21203/rs.3.rs-7381014/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"88654295804699386944038993464749963304","date":"2025-09-21T01:10:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-18T06:55:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89433120032380427481873541523387045007","date":"2025-09-12T04:43:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-11T06:46:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-22T06:25:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-19T09:32:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-19T09:31:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2025-08-15T11:31:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c1abf048-5e64-426d-86a4-bf2ee124b878","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T09:27:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 09:27:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7381014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7381014","identity":"rs-7381014","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}