Nephro Flash Vol-6, No-1, 2020

Acute kidney injury (AKI) and sepsis are frequent complications in critical care patients. The incidence of AKI in adult ICU patients has been reported to range between 16 and 67%. In addition, a plethora of evidence points toward an increasing AKI incidence at a rate of 2.8% annually. Similar increases have also been observed in the pediatric population. This increased prevalence has been associated with consistently raised mortality and morbidity in adults and children. Likewise, the incidence of sepsis or septic shock, one of the common mediators of critical illness is high and continuously rising with an average annual increase of 13%. In fact, sepsis is considered to be the most common factor contributing to the development of AKI. About 26-50% of AKI cases are attributed to sepsis as compared to primary kidney disease which accounts for just 7-10% of cases.1 AKI incidence is reported to increase with sepsis severity. In a cohort of 315 patients, AKI incidence was shown to be 4.2% for sepsis, 22.7% for severe sepsis, and 52.8% for septic shock (Figure 1).

End-stage renal disease (ESRD) has emerged as an important public health issue worldwide due to the marked increase in its incidence and prevalence worldwide. Regardless of the fact that maintenance hemodialysis has been successful in prolonging survival of patients with ESRD, mortality rates still remain high. The annual mortality rates of hemodialysis patients in India have been estimated to be 9-13%. Moreover, the all-cause mortality rates in dialysis patients have been reported to be 6.3-8.2 times higher in patients undergoing dialysis as compared to the healthy population.1 One of the major causes of mortality in hemodialysis patients is sudden cardiac death which is attributed to hyperkalemia, thus signifying the importance of serum potassium evaluation in dialysis management. However, hypokalemia has emerged as another important cause which often remains underestimated and requires marked consideration and attention in terms of hemodialysis- associated mortality.