Community-Acquired Acute Kidney Injury in Central India: Etiology, Clinical Profile, and In-Hospital Outcomes

Background Community-acquired acute kidney injury (CA-AKI) remains a significant public health challenge, characterized by diverse etiologies and variable outcomes. Despite its burden, prospective data from Central India are scarce. This study aimed to systematically delineate the etiological spectrum, clinical characteristics, and in-hospital outcomes of patients with CA-AKI admitted to a tertiary care center in Central India. Methods We conducted a prospective observational study of patients presenting with CA-AKI to a tertiary care center in Central India. Eligible participants were identified at admission based on KDIGO (Kidney Disease: Improving Global Outcomes) criteria, and detailed clinical, laboratory, and etiological data were systematically recorded. Patients were stratified by AKI stage and underlying etiology, with outcomes assessed in terms of renal recovery, complications, and mortality. Results Among 264 patients, infections emerged as the leading cause of CA-AKI (142, 53.8%), most frequently respiratory (52, 19.7%), urinary tract (34, 12.9%), and gastrointestinal (25, 9.5%). Sepsis (73, 27.7%) and volume depletion (50, 18.9%) were the predominant mechanisms. The cohort was predominantly men (172, 65.2%) with a mean age of 52.2±16.0 years. Pre-renal AKI was most common (197, 74.6%), followed by intrinsic renal (55, 20.9%) and post-renal (12, 4.5%) disease. Hypertension (98, 37.1%), diabetes mellitus (75, 28.4%), and chronic liver disease (40, 15.2%) were frequent comorbidities. At presentation, Stage 1 AKI predominated (157, 59.5%), with Stage 2 (57, 21.6%) and Stage 3 (50, 18.9%) being less common. Renal replacement therapy was required in 20 patients (7.6%). Recovery was highest in pre-renal AKI (125, 78.1%) and Stage 1 AKI (113, 71%). Overall mortality was 32 (12.1%). Mortality was strongly associated with complications, including multi-organ dysfunction syndrome (odds ratio (OR) 4.56; 95% confidence interval (CI), 1.33-15.66; p=0.016), need for mechanical ventilation (OR 17.3; 95% CI, 5.22-57.19; p=0.001), and encephalopathy (OR 6.32; 95% CI, 1.68-23.83; p=0.006). Conclusions Infections represent the most prominent etiology of CA-AKI in Central India, with sepsis and volume depletion as the predominant mechanisms. Patients with pre‑renal AKI and those presenting at stage 1 AKI were more often associated with better renal recovery, underscoring the potential reversibility of early disease when promptly recognized, whereas the development of complications, such as multi-organ dysfunction and respiratory failure, was associated with increased mortality. These findings underscore the urgent need for region-specific strategies that strengthen infection control, improve access to early care, and prioritize aggressive management of complications to reduce the burden of CA-AKI in resource-limited settings.