Incidence and Outcomes of Acute Kidney Injury in Critically Ill Patients: A Retrospective Study at a Tertiary Care Hospital

<ns3:p> Background Acute kidney injury is common among critically ill patients and is associated with longer ICU stay, higher resource use and increased mortality. Evidence from low- and middle-income countries, including Nepal, remains limited. This study describes the incidence, severity distribution and clinical outcomes of AKI in a tertiary care ICU. Methods We conducted a hospital based retrospective observational study at Dhulikhel Hospital, Nepal. All adults admitted to the ICU from 1 <ns3:sup>st</ns3:sup> may 2023 to 30 <ns3:sup>th</ns3:sup> April 2024 were screened using ICU registry. AKI was defined and staged using KDIGO serum criteria. Demographic data, comorbidities, ICU interventions and outcomes were extracted. Associations were examined using appropriate statistical tests. Results Among 1113 patients, 1064 were enrolled for analysis. The incidence of AKI was 29.6%. Patients with AKI were older (median age 60 vs 55 years, p &lt; 0.001), had longer ICU stays (median 3 vs 2 days, p &lt; 0.001), were more frequently on invasive mechanical ventilation (39.6%vs 26%, p &lt; 0.001). Type 2 diabetes mellitus was significantly associated with AKI (39.0% vs 28.0%, p = 0.001). AKI severity correlated with worse outcomes including higher mortality and adverse outcomes increasing from 12.7% in patients without AKI to 38% in stage 3 AKI. Renal replacement therapy was required in 2.3% of patients, mainly in stage 2 and 3 AKI. Conclusion Acute kidney injury is a common and a serious complication among critically ill patients, associated with increased mortality and prolonged ICU stay. Early recognition and targeted management strategies, particularly for high-risk groups, are needed in resource limited settings. </ns3:p>