Long-term outcomes of community-acquired versus hospital-acquired acute kidney injury: a retrospective analysis

Pj, Der Mesropian; Js, Kalamaras; Eisele, George; Kr, Phelps; Asif, Arif; Ro, Mathew

doi:10.5414/cn108153

Cited by 45 publications

(43 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even as a relatively new study concept, several risk factors for CA-AKI have been identified, many of which are reflective of those for HA-AKI, such as age, diabetes, congestive HF, CKD, human immunodeficiency virus, obstructive uropathy, and volume depletion [1, 9]. Patients with CA-AKI are more likely to have comorbidities than patients with HA-AKI [17].…”

Section: Discussionmentioning

confidence: 99%

“…Identification in the hospital is more common and typically more severe than CA-AKI as identified in primary care; however, both have been associated with increased mortality [9]. A Veterans Affairs Center study revealed that 23.6% of patients hospitalized from 2004 to 2005 in Upstate New York had AKI, and approximately 78% of those instances were attributed to CA-AKI, indicating that primary care clinics should regularly screen for AKI before the patient deteriorates and requires hospitalization [9]. Additionally, CA-AKI has been shown to be predictive of a poor clinical course, progression to CKD, and death, with 5-year mortality as high as 64% [4, 23].…”

Section: Discussionmentioning

confidence: 99%

“…CA-AKI rates are known to vary based on the detection location, i.e., at the hospital or at the primary care clinic [22]. Identification in the hospital is more common and typically more severe than CA-AKI as identified in primary care; however, both have been associated with increased mortality [9]. A Veterans Affairs Center study revealed that 23.6% of patients hospitalized from 2004 to 2005 in Upstate New York had AKI, and approximately 78% of those instances were attributed to CA-AKI, indicating that primary care clinics should regularly screen for AKI before the patient deteriorates and requires hospitalization [9].…”

Section: Discussionmentioning

confidence: 99%

“…With regard to HF, specifically, Bansal et al [8] determined that patients who developed HA-AKI had a 23% increased risk for HF development within 2 years, as defined by ≥1 hospitalization or ≥2 outpatient visits with a diagnosis of HF. This is particularly concerning, as some studies suggest that CA-AKI may be >3 times as common as HA-AKI, and >5.7 million adults in America have HF, with an incidence nearing 1 per 100 over 65 years of age [9-11]. Hence, we aimed to study the impact of CA-AKI on HF development, as defined by de novo inpatient HF hospitalization.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Tecson¹,

Hashemi²,

Afzal³

et al. 2019

Cardiorenal Med

View full text Add to dashboard Cite

Objectives: Because patients with hospital-acquired acute kidney injury (AKI) are at risk for subsequent development of heart failure (HF) and little is known about the relation between community-acquired AKI (CA-AKI) and HF, we sought to determine if CA-AKI is a risk factor for incident HF hospitalization. Methods: We utilized Baylor Scott & White Health databases at the primary care and inpatient hospitalization levels to identify adults without a prior history of HF who had 2 or more serum creatinine measurements within 13 months in the primary care setting. We defined CA-AKI as a serum creatinine increase ≥0.3 mg/dL or ≥1.5 times the baseline for consecutive values within a 13-month period. We created a flag for de novo HF hospitalization at 90, 180, and 365 days following CA-AKI evaluation. Results: In the analyses, 210,895 unique adults were included, of whom 5,358 (2.5%) had CA-AKI. Those with CA-AKI had higher rates of comorbidities, higher rate of males (48 vs. 42%, p < 0.001), and were older (61.5 [50.3, 73.1] vs. 54.1 [42.8, 64.7] years, p < 0.001) than those who did not have CA-AKI. In total, 607 (0.3%), 833 (0.4%), and 1,089 (0.5%) individuals had an incident HF hospitalization in the 90, 180, and 365 days following the CA-AKI evaluation, respectively. After adjusting for demographic and clinical characteristics, patients with CA-AKI had >2 times the risk of de novo HF hospitalization compared with patients who did not have CA-AKI (90 days: 2.35 [1.83–3.02], p < 0.001; 180 days: 2.52 [2.04–3.13], p < 0.001; 365 days: 2.16 [1.77–2.64], p < 0.001). These multivariable models yielded strong predictive abilities, with the areas under the receiver-operating characteristic curve >0.90. Conclusion: After controlling for baseline and clinical characteristics, patients with CA-AKI were at approximately twofold the risk of de novo HF hospitalization (within 90, 180, and 365 days) compared with those who did not have CA-AKI. Hence, detecting CA-AKI may provide an opportunity for early intervention at the primary care level to possibly delay HF development.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Tecson¹,

Hashemi²,

Afzal³

et al. 2019

Cardiorenal Med

View full text Add to dashboard Cite

show abstract

“…3 The present study evaluated the renal effects of optimizing potentially nephrotoxic medications in an older population. The hypothesis is that avoidance of polypharmacy is associated with improved renal function.…”

Section: Introductionmentioning

confidence: 99%

Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients

et al. 2015

View full text Add to dashboard Cite

Background: Elderly patients are particularly susceptible to polypharmacy. The present study evaluated the renal effects of optimizing potentially nephrotoxic medications in an older population. Methods: Retrospective study of patients' 60 years treated between January of 2013 and February of 2015 in a Nephrology Clinic. The renal effect of avoiding polypharmacy was studied. Results: Sixty-one patients were studied. Median age was 81 years (range 60-94). Twenty-five patients (41%) were male. NSAIDs alone were stopped in seven patients (11.4%), a dose reduction in antihypertensives was done in 11 patients (18%), one or more antihypertensives were discontinued in 20 patients (32.7%) and discontinuation and dose reduction of multiple medications was carried out in 23 patients (37.7%). The number of antihypertensives was reduced from a median of 3 (range of 0-8) at baseline to a median of 2 (range 0-7), p50.001 after intervention. After intervention, the glomerular filtration rate (GFR) improved significantly, from a baseline of 32 ± 15.5 cc/min/1.73m 2 to 39.5 ± 17 cc/min/1.73m 2 at t1 (p50.001) and 44.5 ± 18.7 cc/min/1.73m 2 at t2 (p50.001 vs. baseline). In a multivariate model, after adjusting for ACEIs/ARBs discontinuation/dose reduction, NSAIDs use and change in DBP, an increase in SBP at time 1 remained significantly associated with increments in GFR on follow-up (estimate ¼ 0.20, p ¼ 0.01). Conclusions: Avoidance of polypharmacy was associated with an improvement in renal function.

show abstract

Community- and Hospital-Acquired Acute Kidney Injury

Peerapornratana

Srisawat

2020

Acute Kidney Injury and Regenerative Medicine

View full text Add to dashboard Cite

Long-term outcomes of community-acquired versus hospital-acquired acute kidney injury: a retrospective analysis

Abstract: CA-AKI was found to be considerably more common than HA-AKI and had similar long-term consequences.

Cited by 45 publications

References 0 publications

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients

Community- and Hospital-Acquired Acute Kidney Injury

Contact Info

Product

Resources

About