Aetiology and Clinical Outcomes of Community-Acquired Acute Kidney Injury: A Prospective Hospital-Based Study from a Tertiary Care Centre in India

Abstract

Background: Community-acquired acute kidney injury (CA-AKI) carries distinct aetiological patterns in tropical developing countries compared with high-income settings, with infectious and nephrotoxic causes predominating over cardiorenal and contrast-related aetiologies. Systematic prospective data on the aetiological spectrum, clinical severity, dialysis requirements, mortality determinants, and renal recovery outcomes of CA-AKI from Indian tertiary care centres remain incompletely documented. This prospective study aimed to characterise the aetiology and clinical outcomes of CA-AKI in an Indian hospital-based cohort. Methods: A prospective observational study was conducted at the Department of Nephrology and General Medicine, B.J. Medical College, Pune, India, enrolling 210 consecutive patients aged 18 years and above presenting with community-acquired AKI, defined by KDIGO 2012 criteria (rise in serum creatinine ≥0.3 mg/dL within 48 hours, or ≥1.5-fold increase from baseline within seven days, or urine output <0.5 mL/kg/h for six or more hours), over a period of Jan 2023 to May 2023. Aetiology was systematically classified. Laboratory parameters, KDIGO staging, SOFA score, dialysis modality and indications, and in-hospital outcomes including renal recovery and mortality were documented. Multivariable logistic regression identified independent predictors of inhospital mortality. Results: The mean age was 46.3 ± 16.8 years, with male predominance (62.9%) and predominantly rural background (65.7%). Tropical infectious aetiologies dominated, with falciparum malaria (18.1%), sepsis (16.2%), leptospirosis (8.6%), dengue haemorrhagic fever (6.7%), and scrub typhus (4.8%) as leading causes. AKI Stage 3 was present in 38.1% of patients; 29.5% required renal replacement therapy (RRT), predominantly intermittent haemodialysis (77.4%). Overall in-hospital mortality was 11.4%, rising to 25.8% among RRT-requiring patients. Complete renal recovery was achieved in 67.6% of patients. SOFA score >8 (adjusted OR 7.4), AKI Stage 3 (OR 6.2), mechanical ventilation (OR 5.8), sepsis aetiology (OR 4.8), and oligoanuria at admission (OR 5.1) were independent predictors of in-hospital mortality (all p<0.01). Model AUC was 0.91. Conclusion: Tropical infectious diseases, predominantly falciparum malaria and sepsis, constitute the dominant aetiological causes of CA-AKI in this Indian tertiary centre population, with a high dialysis rate and significant in-hospital mortality, particularly among patients with severe AKI and sepsis. SOFA score, KDIGO staging, and oligoanuria at admission are the strongest mortality predictors. These findings support region-specific AKI management protocols, early nephrology referral, and integrated public health strategies targeting tropical infections in India.