Incidence and Outcomes in Acute Kidney Injury

Abstract

Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought. We tested the hypothesis that the incidence is higher by including all patients with AKI (in a geographical population base of 523,390) regardless of whether they required renal replacement therapy irrespective of the hospital setting in which they were treated. We also tested the hypothesis that the Risk, Injury, Failure, Loss, and End-Stage Kidney (RIFLE) classification predicts outcomes. We identified all patients with serum creatinine concentrations >150 mol/L (male) or >130mol/L (female) over a 6-mo period in 2003. Clinical outcomes were obtained from each patient's case records. The incidences of AKI and ACRF were 1811 and 336 per million population, respectively. Median age was 76 yr for AKI and 80.5 yr for ACRF. Sepsis was a precipitating factor in 47% of patients. The RIFLE classification was useful for predicting full recovery of renal function (P < 0.001), renal replacement therapy requirement (P < 0.001), length of hospital stay [excluding those who died during admission (P < 0.001)], and in-hospital mortality (P ‫؍‬ 0.035). RIFLE did not predict mortality at 90 d or 6 mo. Thus the incidence of AKI is much higher than previously thought, with implications for service planning and providing information to colleagues about methods to prevent deterioration of renal function. The RIFLE classification is useful for identifying patients at greatest risk of adverse short-term outcomes.

Review article: Acute kidney injury in critical illness

“…8 Data also indicate that the incidence is increasing significantly, while crude mortality rates have improved only marginally. [9][10][11] These data imply that the burden of illness attributable to AKI has increased, and while mortality rates are relatively stable, these figures will still translate into a greater absolute number of deaths for patients with AKI. There are plausible explanations for these trends.…”

Sitagliptin protects rat kidneys from acute ischemia-reperfusion injury via upregulation of GLP-1 and GLP-1 receptors

“…Among the various etiologies of hospital-acquired AKI, ischemia-reperfusion (IR) injury is the leading cause of AKI [11][12][13] and is associated with high mortality [14,15] . Surprisingly, although the epidemiology, etiologies, mechanisms, classification, and prognostic outcomes of acute IR kidney injury have been widely investigated for several decades [16][17][18] , there are still no effective therapeutic strategies for this condition other than supportive treatment. Accordingly, the development of new treatment modalities for acute IR kidney injury is needed [19] .…”

Epidemiology of Acute Kidney Injury

“…Recent studies in the United States (4,5) and Spain (6) have shown incidences varying between an average of 23.8 cases per 1000 discharges (4) with an 11% yearly increase between 1992 and 2001, to an increase from 61 to 288 per 100,000 population between 1988 and 2002 (5). More recently, Ali et al (7) reported a high incidence of 1811 cases of AKI per million population during 2003. The relatively wide disparity in reported incidence rates and the increasing frequency of the condition raise concerns as to the real magnitude of the problem.…”