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BMC Nephrology
Published in: BMC Nephrology 1/2014

Open Access 01-12-2014 | Research article

What is the real impact of acute kidney injury?

Authors: Michael Bedford, Paul E Stevens, Toby WK Wheeler, Christopher KT Farmer

Published in: BMC Nephrology | Issue 1/2014

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Abstract

Background

Acute kidney injury (AKI) is a common clinical problem. Studies have documented the incidence of AKI in a variety of populations but to date we do not believe the real incidence of AKI has been accurately documented in a district general hospital setting.
The aim here was to describe the detected incidence of AKI in a typical general hospital setting in an unselected population, and describe associated short and long-term outcomes.

Methods

A retrospective observational database study from secondary care in East Kent (adult catchment population of 582,300). All adult patients (18 years or over) admitted between 1st February 2009 and 31st July 2009, were included. Patients receiving chronic renal replacement therapy (RRT), maternity and day case admissions were excluded. AKI was defined by the acute kidney injury network (AKIN) criteria. A time dependent risk analysis with logistic regression and Cox regression was used for the analysis of in-hospital mortality and survival.

Results

The incidence of AKI in the 6 month period was 15,325 pmp/yr (adults) (69% AKIN1, 18% AKIN2 and 13% AKIN3). In-hospital mortality, length of stay and ITU utilisation all increased with severity of AKI. Patients with AKI had an increase in care on discharge and an increase in hospital readmission within 30 days.

Conclusions

This data comes closer to the real incidence and outcomes of AKI managed in-hospital than any study published in the literature to date. Fifteen percent of all admissions sustained an episode of AKI with increased subsequent short and long term morbidity and mortality, even in those with AKIN1. This confers an increased burden and cost to the healthcare economy, which can now be quantified. These results will furnish a baseline for quality improvement projects aimed at early identification, improved management, and where possible prevention, of AKI.
Appendix
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Literature
1.
Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, Paganini EP, Chertow GM, Program to Improve Care in Acute Renal Disease: Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004, 66 (4): 1613-1621.CrossRefPubMed
2.
Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W: Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002, 30 (9): 2051-2058.CrossRefPubMed
3.
Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL: Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006, 1 (1): 43-51.CrossRefPubMed
4.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005, 294 (7): 813-818.CrossRefPubMed
5.
Levy MM, Macias WL, Vincent JL, Russell JA, Silva E, Trzaskoma B, Williams MD: Early changes in organ function predict eventual survival in severe sepsis. Crit Care Med. 2005, 33 (10): 2194-2201.CrossRefPubMed
6.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup: Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus conference of the Acute Dialysis Quality Initiative (ADQI) group. Crit Care. 2004, 8 (4): R204-R212.CrossRefPubMedPubMedCentral
7.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006, 10 (3): R73-CrossRefPubMedPubMedCentral
8.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network: Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007, 11 (2): R31-CrossRefPubMedPubMedCentral
9.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005, 16 (11): 3365-3370.CrossRefPubMed
10.
Kohli HS, Bhat A, Jairam A, Aravindan AN, Sud K, Jha V, Gupta KL, Sakhuja V: Predictors of mortality in acute renal failure in a developing country: a prospective study. Ren Fail. 2007, 29 (4): 463-469.CrossRefPubMed
11.
Arije A, Kadiri S, Akinkugbe OO: The viability of hemodialysis as a treatment option for renal failure in a developing economy. Afr J Med Med Sci. 2000, 29 (3–4): 311-314.PubMed
12.
Chugh KS: Renal disease in India. Am J Kidney Dis. 1998, 31 (3): Ivii-Iix.PubMed
13.
Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E: Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics. 2006, 118 (3): e786-e791.CrossRefPubMed
14.
Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL: 3–5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006, 69 (1): 184-189.CrossRefPubMed
15.
Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, Himmelfarb J, Collins AJ: Incidence and mortality of acute renal failure in medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006, 17 (4): 1135-1142.CrossRefPubMed
16.
Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM: Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006, 17 (4): 1143-1150.CrossRefPubMed
17.
Stevens PE, Tamimi NA, Al-Hasani MK, Mikhail AI, Kearney E, Lapworth R, Prosser DI, Carmichael P: Non-specialist management of acute renal failure. QJM. 2001, 94 (10): 533-540.CrossRefPubMed
18.
Metcalfe W, Simpson M, Khan IH, Prescott GJ, Simpson K, Smith WC, MacLeod AM, Scottish Renal Registry: Acute renal failure requiring renal replacement therapy: incidence and outcome. QJM. 2002, 95 (9): 579-583.CrossRefPubMed
19.
Hegarty J, Middleton RJ, Krebs M, Hussain H, Cheung C, Ledson T, Hutchison AJ, Kalra PA, Rayner HC, Stevens PE, O’Donoghue DJ: Severe acute renal failure in adults: place of care, incidence and outcomes. QJM. 2005, 98 (9): 661-666.CrossRefPubMed
20.
Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, Macleod A: Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007, 18 (4): 1292-1298.CrossRefPubMed
21.
22.
Lafrance JP, Miller DR: Defining acute kidney injury in database studies: the effects of varying the baseline kidney function assessment period and considering CKD status. Am J Kidney Dis. 2010, 56 (4): 651-660.CrossRefPubMed
23.
24.
Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005, 43 (11): 1130-1139.CrossRefPubMed
25.
Hux JE, Ivis F, Flintoft V, Bica A: Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care. 2002, 25 (3): 512-516.CrossRefPubMed
26.
27.
28.
Kolhe NV, Stevens PE, Crowe AV, Lipkin GW, Harrison DA: Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC case mix programme database. Crit Care. 2008, 12 (Suppl 1): S2-CrossRefPubMedPubMedCentral
29.
Siew ED, Ikizler TA, Matheny ME, Shi Y, Schildcrout JS, Danciu I, Dwyer JP, Srichai M, Hung AM, Smith JP, Peterson JF: Estimating baseline kidney function in hospitalized patients with impaired kidney function. Clin J Am Soc Nephrol. 2012, 7 (5): 712-719.CrossRefPubMedPubMedCentral
30.
Siew ED, Matheny ME, Ikizler TA, Lewis JB, Miller RA, Waitman LR, Go AS, Parikh CR, Peterson JF: Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury. Kidney Int. 2010, 77 (6): 536-542.CrossRefPubMed
31.
Siew ED, Peterson JF, Eden SK, Moons KG, Ikizler TA, Matheny ME: Use of multiple imputation method to improve estimation of missing baseline serum creatinine in acute kidney injury research. Clin J Am Soc Nephrol. 2013, 8 (1): 10-18.CrossRefPubMed
Metadata
Title
What is the real impact of acute kidney injury?
Authors
Michael Bedford
Paul E Stevens
Toby WK Wheeler
Christopher KT Farmer
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2014
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/1471-2369-15-95

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