Incidence of Acute Kidney Injury in patients with ≥10% TBSA burns admitted to an Australian Burns Centre

Dr Lara Kimmel1,2, Dr Scott WIlson3,4,5, Professor Rowan Walker3,4, Ms Yvonne Singer6, Miss Heather Cleland6,7

1Physiotherapy Department, The Alfred, Melbourne, Australia, 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, 3Department of Renal Medicine, The Alfred, Melbourne, Australia, 4Department of Medicine, Monash University, Melbourne, Australia, 5Baker IDI, Melbourne, Australia, 6Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 7Department of Surgery, Monash University, Melbourne, Australia

Background: Acute Kidney Injury (AKI) complicates the management of approximately 25% of patients with severe burns and is associated with long term complications. The aims of this study were to examine the incidence of, and factors associated with, the development of AKI in patients with %TBSA ≥10, as well as the relationship with length of stay (LOS).

Methods: Retrospective medical record review of consecutive burns patients admitted to The Alfred.  Demographic and injury details were recorded. Factors associated with AKI were determined using multiple logistic regression.

Results: Between 2010 and June 2014, 300 patients were admitted with burn injury and data on 267 patients was available for analysis.  Median age was 54.5 years with 78% being male.  Median %TBSA was 15 (IQR 12, 20).  The AKI incidence was 22.5%, including 15% (27/184) in patients with %TBSA 10-19. Factors associated with AKI included increasing age and %TBSA (OR 1.05 p<0.001) as well as increased surgeries (p<0.041) and a cardiac comorbidity (p<0.01). All patients with renal comorbidity developed AKI. In the %TBSA 10-19 cohort, only increasing age (OR 1.05 p < 0.001) was associated with AKI. After accounting for confounding factors, the probability of discharge in non-AKI group was greater than for the AKI patients at all time points (p<0.001).

Conclusion: This is the first study to show an association between patients with %TBSA 10-19 and AKI.  Given the association between AKI and complications, prospective research is needed to further understand AKI in burns with the aim of risk reduction.

Lara has worked as a physiotherapist at The Alfred for over 20 years, mainly in the area of trauma and orthopaedics.  She completed her PhD through Monash University in 2016 and has a wide variety of research interests.

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