Referral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury

Meier, Pascal; Bonfils, Rachel Meier; Vogt, Bruno; Burnand, Bernard; Burnier, Michel

doi:10.2215/cjn.01880211

Cited by 78 publications

(74 citation statements)

References 33 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even mild AKI is no longer considered to be benign, but rather an independent predictor of mortality (18,19,25). Surprisingly, our data demonstrated that more severe AKI was not necessarily associated with worse outcomes.…”

Section: Discussionmentioning

confidence: 51%

See 1 more Smart Citation

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

252

245

View full text Add to dashboard Cite

Background and objective Compared with AKI in hospitalized patients, little is known about patients sustaining AKI in the community and how this differs from AKI in hospital. This study compared epidemiology, risk factors, and short-and long-term outcomes for patients with community-acquired (CA) and hospital-acquired (HA) AKI.Design, setting, participants, & measurements A total of 15,976 patients admitted to two district general hospitals between July 11, 2011, and January 15, 2012 were studied. Through use of an electronic database and the AKI Network classification, 686 patients with CA-AKI and 334 patients with HA-AKI were identified. Patients were followed up for 14 months, and data were collated on short-term and long-term renal and patient outcomes.Results The incidence of CA-AKI among all hospital admissions was 4.3% compared with an incidence of 2.1% of HA-AKI, giving an overall AKI incidence of 6.4%. Patients with CA-AKI were younger than patients with HA-AKI. Risks for developing HA and CA-AKI were similar and included preexisting CKD, cardiac failure, ischemic heart disease, hypertension, diabetes, dementia, and cancer. Patients with CA-AKI were more likely to have stage 3 AKI and had shorter lengths of hospital stay than patients with HA-AKI. Those with CA-AKI had better (multivariate-adjusted) survival than patients with HA-AKI (hazard ratio, 1.8 [95% CI, 1.44-2.13; P,0.001] for HA-AKI group). Mortality for the CA-AKI group was 45%; 43.7% of these deaths were acute inhospital deaths. Mortality for the HA-AKI group was 62.9%, with 68.1% of these deaths being acute in-hospital deaths. Renal referral rates were low across the cohorts (8.3%). Renal outcomes were similar in both CA-AKI and HA-AKI groups, with 39.4% and 33.6% of patients in both groups developing de novo CKD or progression of preexisting CKD within 14 months, respectively. ConclusionPatients with CA-AKI sustain more severe AKI than patients with HA-AKI. Despite having risk factors similar to those of patients with HA-AKI, patients with CA AKI have better short-and long-term outcomes.

show abstract

Section: Discussionmentioning

confidence: 51%

“…AKI is an important contributor to CKD. Previous studies have highlighted increased risks of de novo CKD following episodes of AKI with incomplete recovery (3,15,16,22,25). In this study, one third of patients developed de novo CKD or progression of preexisting CKD.…”

Section: Discussionmentioning

confidence: 73%

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

252

245

View full text Add to dashboard Cite

show abstract

“…CKD was identified by the diagnosis codes, a baseline eGFR,60 ml/min per 1.73 m 2 in patients with AKI, or the highest eGFR,60 ml/min per 1.73 m 2 in patients without AKI (19). The burden of comorbidity was determined using the Charlson comorbidity score (20).…”

Section: Determination Of Comorbiditymentioning

confidence: 99%

Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults

Nie

Liu

et al. 2015

Clinical Journal of the American Society of Nephrology

239

234

View full text Add to dashboard Cite

Background and objectives Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China.Design, setting, participants, & measurements This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and communityacquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed.Results The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders.Conclusion AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization.

show abstract

“…Although consistent with data from South Africa (SA), [17] this is in contrast to the distribution of AKI in the developed world which predominantly occurs in elderly male populations. [19][20][21] The data also suggest that AKI associated with intrinsic renal disease/glomerular injury presents predominantly as AKI3. This is also in keeping with our previous data from Ethiopia in which 48% of patients presented with AKI3.…”

Section: Discussionmentioning

confidence: 88%