Pre-Stage Acute Kidney Injury Can Predict Mortality and Medical Costs in Hospitalized Patients

Abstract

The significance of minimal increases in serum creatinine below the levels indicative of the acute kidney injury (AKI) stage is not well established. We aimed to investigate the influence of pre-stage AKI (pre-AKI) on clinical outcomes. We enrolled a total of 21,261 patients who were admitted to the Seoul National University Bundang Hospital from January 1, 2013 to December 31, 2013. Pre-AKI was defined as a 25–50% increase in peak serum creatinine levels from baseline levels during the hospital stay. In total, 5.4% of the patients had pre-AKI during admission. The patients with pre-AKI were predominantly female (55.0%) and had a lower body weight and lower baseline levels of serum creatinine (0.63 ± 0.18 mg/dl) than the patients with AKI and the patients without AKI (P < 0.001). The patients with pre-AKI had a higher prevalence of diabetes mellitus (25.1%) and malignancy (32.6%). The adjusted hazard ratio of in-hospital mortality for pre-AKI was 2.112 [95% confidence interval (CI), 1.143 to 3.903]. In addition, patients with pre-AKI had an increased length of stay (7.7 ± 9.7 days in patients without AKI, 11.4 ± 11.4 days in patients with pre-AKI, P < 0.001) and increased medical costs (4,061 ± 4,318 USD in patients without AKI, 4,966 ± 5,099 USD in patients with pre-AKI, P < 0.001) during admission. The adjusted hazard ratio of all-cause mortality for pre-AKI during the follow-up period of 2.0 ± 0.6 years was 1.473 (95% CI, 1.228 to 1.684). Although the adjusted hazard ratio of pre-AKI for overall mortality was not significant among the patients admitted to the surgery department or who underwent surgery, pre-AKI was significantly associated with mortality among the non-surgical patients (adjusted HR 1.542 [95% CI, 1.330 to 1.787]) and the patients admitted to the medical department (adjusted HR 1.384 [95% CI, 1.153 to 1.662]). Pre-AKI is associated with increased mortality, longer hospital stay, and increased medical costs during admission. More attention should be paid to the clinical significance of pre-AKI.

Acute kidney injury and mortality in pediatric Lassa fever versus question of access to dialysis

“…The high CFR of 56% among the children with AKI is consistent with the increased mortality associated with AKI complicating LF (Asogun et al, 2012;Okokhere et al 2018, Akpede et al 2019 and other VHFs (Muhammad et al, 2012;Hunt et al, 2015). The AKI stage-related mortality is also consistent with reports from previous studies (Murugan and Kellum, 2011;Wang et al, 2012;Mallhi et al, 2015a;Naqvi, 2016;Lee et al, 2016). Therefore, early detection and appropriate management, perhaps especially, access to renal support, could greatly reduce the mortality in hospitalized pediatric patients with LF.…”

Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study

“…Another study also showed that even patients with a 25–50% increase in peak serum creatinine levels from baseline have an increased risk of mortality. Stage of AKI is reported to be a predictor for mortality and decreased kidney function, correlate with short term and even longer-term adverse outcomes 1 , 29 .…”

Awareness, incidence and clinical significance of acute kidney injury after non-general anesthesia

“…[1,4] It is strongly associated with poor prognosis, [5–9] and even a small elevation in serum creatinine (sCr) level was shown to be associated with an increased risk of patient mortality or progression to end-stage renal disease. [10–13] However, most studies on postoperative AKI were performed in patients undergoing major surgeries that are mainly performed under general anesthesia (GA). [11,12,14] Also, clinicians commonly consider that surgeries under non-GA are relatively safer than GA surgeries regarding AKI risks, but evidence concerning this issue is scarce.…”