The Incidence of Acute Kidney Injury and Associated Hospital Mortality

Abstract

cute kidney injury (AKI) is a frequent (8% to 22% of all hospital patients) and relevant clinical event (1, 2). It is characterized by a rapid worsening of kidney function to varying degrees and is associated with a 1.4-to 15.4-fold increase in the risk of mortality (3-6). Patients with AKI are also at considerable risk for the development or worsening of chronic kidney disease (7-10).AKI is currently defined and staged depending on changes in serum creatinine and urine excretion according to the KDIGO AKI guidelines (Table 1) (10,11). According to international guidelines, the diagnosis of AKI should prompt a number of steps. These include identifying and treating triggering factors, adjusting drug doses to impaired renal function, avoiding nephrotoxins, monitoring of hemodynamics as well as fluid and electrolyte balance, and nephro- SummaryBackground: Studies from multiple countries have shown that acute kidney injury (AKI) in hospitalized patients is associated with mortality and morbidity. There are no reliable data at present on the incidence and mortality of AKI episodes among hospitalized patients in Germany. The utility of administrative codings of AKI for the identification of AKI episodes is also unclear.Methods: In an exploratory approach, we retrospectively analyzed all episodes of AKI over a period of 3.5 years (2014-2017) on the basis of routinely obtained serum creatinine measurements in 103 161 patients whose creatinine had been measured at least twice and who had been in the hospital for at least two days. We used the "Kidney Disease: Improving Global Outcomes" (KDIGO) criteria for AKI. In parallel, we assessed the administrative coding of discharge diagnoses of the same patients with codes from the International Classification of Diseases (ICD-10-GM).Results: Among 185 760 hospitalizations, stage 1 AKI occurred in 25 417 cases (13.7%), stage 2 in 8503 cases (4.6%), and stage 3 in 5881 cases (3.1%). AKI cases were associated with length of hospital stay, renal morbidity, and overall mortality, and this association was stage-dependent. The in-hospital mortality was 5.1% for patients with stage 1 AKI, 13.7% for patients with stage 2 AKI, and 24.8% for patients with stage 3 AKI. An administrative coding for acute kidney injury (N17) was present in only 28.8% (11 481) of the AKI cases that were identified by creatinine criteria. Like the AKI cases overall, those that were identified by creatinine criteria but were not coded as AKI had significantly higher mortality, and this association was stage-dependent.Conclusion: AKI episodes are common among hospitalized patients and are associated with considerable morbidity and mortality, yet they are inadequately documented and probably often escape the attention of the treating physicians.

Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications

“…AKI is common among hospitalized patients (incidence 8–22%) and is associated with increased morbidity and mortality [ 15 , 16 , 17 ]. In our cohort of 469 COVID-19 patients, a relatively higher percentage of patients (27.3%, 128 of 469) developed in-hospital AKI.…”

Critical Illness and Systemic Inflammation Are Key Risk Factors of Severe Acute Kidney Injury in Patients With COVID-19

“…This would be consistent with our observation that most of the cases of AKI in our cohort were KDIGO stage 3, in sharp contrast to a previous retrospective analysis of AKI cases in the same health care setting before the onset of the pandemic, where less severe AKI stages were substantially more frequent compared with stage 3. 41 …”

Drug-Induced Acute Kidney Injury: A Study from the French Medical Administrative and the French National Pharmacovigilance Databases Using Capture-Recapture Method

“…In cases of functional AKI, code R39.2 “Extrarenal uremia” should be used. On the contrary, in Germany, the German Society of Nephrology recommended coding N17 when AKI met the KDIGO definition [ 39 ]. As a consequence, the ability of an association of codes to detect ADR has to be established in each country.…”