Towards 0 by 25: Changing Patterns of Community Acquired Acute Kidney Injury - A Ten-year Retrospective Study From South India

BACKGROUND Community-acquired acute kidney injury (CA AKI)represents a significant public health challenge characterized by substantial obstacles in the realms of early diagnosis and therapeutic management. Among various medical aetiologies of CA AKI, infections dominate over non-infectious factors. The initiative spearheaded by the ISN, known as 0 by 25, seems implausible in LMICs, primarily due to deficiencies in documentation, infrastructural capabilities, specialized expertise, and other interdepartmental public health strategies. This study analyses evolving trends in etiological factors contributing to CA AKI, with a particular emphasis on mortality of reaching the goal of 0 by 25. Methods: This study is a retrospective, single-centre analysis of cases admitted with CA AKI from 2014 to 2023. We focussed on the shifting spectrum of CA AKI and the mortality rates. Results: Of the 6,040 AKI cases, we included 5,736 cases of CA AKI. Surgical, obstetric, and paediatric Covid cases were excluded. Causes of CA AKI between 2014 and 2018 included infections such as sepsis/MODS, pneumonia, UTI, and gastroenteritis; conversely, between 2019 and 2023, non-infectious causes emerged, including pancreatitis, paraquat toxicity and obstructive uropathy secondary to cervical carcinoma. Mortality rates in both time frames ranged from 19% to 25%; risk factors identified included advanced age, MODS, hypoalbuminemia, and hypoxia. Notably, a decline in tropical infections such as malaria and dengue was documented, whereas the prevalence of leptospirosis and scrub typhus remained unchanged. Conclusion: A discernible change has emerged in the causes of community-acquired acute kidney injury (CA AKI). While infectious issues like sepsis and pneumonia still lead the group, a rise in non-infectious causes over the past five years is a major concern. Mortality rates linked to CA AKI remain strikingly high, between 19% and 25%. In resource-constrained settings, reaching a target of 0 by 2025 will certainly pose a significant challenge.