Serum Creatinine Trajectories for Community- versus Hospital-Acquired Acute Kidney Injury

Abstract

Background: Patterns of acute kidney injury (AKI) can be distinguished by the rate of changes in the serum creation concentrations during hospitalizations. We hypothesized that the timing and values of minimum and maximum serum creatinine (sCr) could be used to distinguish between transient hospital-associated AKI (THA-AKI) and hospital-acquired AKI (HA-AKI). Materials and Methods: We evaluated adults admitted to 2 regionally distinct academic medical centers. Peak sCr during the hospitalization was used to define AKI, using absolute changes and timing from the minimum sCr. sCr trajectories were derived based on the rate of change between the minimum and peak creatinine concentrations. Results: Peak creatinine followed the minimum creatinine for HA-AKI, while the peak creatinine preceded the minimum creatinine for THA-AKI. There were 82,403 patients included in the analyses, and 53,882 (65%) did not have AKI during the index hospitalization. There were 2,611 inpatient deaths; HA-AKI had a 4.8-fold increased risk relative to those without AKI (p < 0.01), and transient AKI had a 1.6-fold increased risk for inpatient mortality relative to inpatients without AKI (p < 0.01). Conclusions: Patients with hospital-associated AKI are at an increased risk for inpatient mortality. Creatinine trajectories can be used to describe the rate of development as well as recovery from inpatient AKI. The 24- and 48-hour interval slopes may be early indicators of developing AKI.

Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies

“…While numerous studies have focused on the epidemiology and clinical outcomes of patients who developed AKI during hospitalization—hospital‐acquired (HA)‐AKI—little is known about community‐acquired (CA)‐AKI (before hospitalization); nine studies have examined it . CA‐AKI was actually about two to four times more common than HA‐AKI.…”

Acute Kidney Injury Recognition in Low- and Middle-Income Countries

“…177 In this approach, the attainment of peak SCr after the initial creatinine elevation is considered an indication of persistent AKI. In LMICs, when community patients reach hospitals with established AKI such time-course information is usually not available.…”

Points of Concern in Post Acute Kidney Injury Management

“…There is currently great interest for incorporating sCr trajectories into the creatinine classification criteria, which would eliminate the need for a baseline sCr value [21-23]. Analysis of sCr trajectories provides the opportunity to develop AKI staging based on the profile of sCr changes over time [22, 23].…”

“…Analysis of sCr trajectories provides the opportunity to develop AKI staging based on the profile of sCr changes over time [22, 23]. In addition, Bhatraju et al [21] demonstrated that the trajectory of sCr defines subphenotypes of AKI that are independently associated with hospital mortality, length of hospital stay, and length of ICU stay.…”