Characteristics and outcomes in community‐acquired versus hospital‐acquired acute kidney injury

Schissler, Michael M; Zaidi, Syed Tabish Razi; Kumar, Hitesh; Deo, Datinder; Brier, Michael E.; McLeish, Kenneth R.

doi:10.1111/nep.12036

Cited by 90 publications

(103 citation statements)

References 26 publications

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“…We compared this cohort with 334 patients who sustained AKI during a hospital stay. The incidence of CA-AKI was higher in the present study than in other studies (9,(20)(21)(22)(23). However, this probably remains an underestimate of the true amount of CA-AKI that exists because numerous patients with CA-AKI will neither have blood tests performed nor be admitted to the hospital.…”

Section: Discussioncontrasting

confidence: 54%

“…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: 70%

“…Two of these studies, based in Brazil and China, had less than a third of the patient numbers presented here (27,28). The causes of AKI, as well as the prevalence of various comorbid conditions in these studies, probably differ from those present in our (22,23). A recent meta-analysis of world AKI incidence found an inverse correlation of AKI-associated mortality and percentage of country gross domestic product spent on health expenditure.…”

Section: Discussionmentioning

confidence: 95%

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

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

260

245

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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.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 95%

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

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

260

245

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“…At present, it is essential to develop health care aimed at prevention in order to mitigate the risks of disease chronification, the worsening of chronic diseases, the onset of new cases and comorbidities. Studies report the frequent onset of AKI primarily in the community by considering that many hospitalized patients present elevated serum creatinine since the time of admission, foretelling a previous history of the disease (13)(14)(15) . The care of individuals with AKI should be a priority regardless of where they are located for promoting their safety (2,16) .…”

Section: Introductionmentioning

confidence: 99%

Risk for acute kidney injury in primary health care

Rigonatto

Magro

2018

Rev. Bras. Enferm.

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Objective: To identify hypertensive and diabetic patients at risk for developing acute kidney injury in the primary health care setting. Method: Observational, longitudinal, prospective study. Sample of 56 diabetic and hypertensive individuals. A semistructured questionnaire was adopted for data collection. For the description of results, were calculated dispersion measures and the Spearman test was used for statistical analysis. The result was considered signifi cant when p <0.05. Results: Of the total sample, 23.2% of users evolved with renal impairment, of which 19.6% with risk for renal injury, and 3.6% with kidney injury itself. Age and body mass index were associated with worsening of renal function (p = 0.0001; p = 0.0003), respectively. Conclusion: A quarter of the health system users, hypertensive and diabetic, evolved with impaired renal function, more specifi cally to stages of risk for renal injury and kidney injury according to the RIFLE classifi cation. Descriptors: Acute Kidney Injury; Primary Health Care; Disease Prevention; Nursing evaluation; Hypertension. RESUMO Objetivo: Identifi car pacientes hipertensos e diabéticos com risco para desenvolver lesão renal aguda no cenário da atenção primária à saúde. Método: Estudo observacional, longitudinal, prospectivo. Casuística composta de 56 indivíduos diabéticos e hipertensos. Adotou-se questionário semiestruturado para coleta de dados. Para descrição dos resultados foram calculadas medidas de dispersão e o teste de Spearman para análise estatística. O resultado foi considerado signifi cativo quando p < 0,05. Resultados: Do total, 23,2% dos usuários evoluíram com comprometimento renal, sendo 19,6% com risco para lesão renal e 3,6% com lesão renal, propriamente dita. A idade e o índice de massa corporal mostraram associação com a piora da função renal (p=0,0001; p=0,0003), respectivamente. Conclusão: Identifi cou-se que um quarto dos usuários do sistema de saúde, hipertensos e diabéticos evoluíram com comprometimento da função renal, mais especifi camente nos estágios de risco e de lesão renal segundo a classifi cação RIFLE. Descritores: Lesão Renal Aguda; Atenção Primária à Saúde; Prevenção de Doenças; Avaliação em Enfermagem; Hipertensão. RESUMEN Objetivo: Identifi car los pacientes hipertensos y diabéticos con riesgo para desarrollar lesión renal aguda en el escenario de la atención primaria de salud. Método: Estudio observacional, longitudinal y prospectivo. Casuística compuesta de 56 individuos diabéticos e hipertensos. Un cuestionario semiestructurado fue adoptado para la recolección de datos. Para la descripción de los resultados, se calcularon medidas de dispersión, y para el análisis estadístico se usó la prueba de Spearman. El resultado se consideró signifi cativo cuando p < 0,05. Resultados: Del total de la muestra, el 23,2% de los usuarios evolucionaron con deterioro renal, siendo el 19,6% con riesgo para lesión renal y el 3,6% con lesión renal. La edad y el índice de masa corporal tuvieron asociación con el empeoramiento de la fun...

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“…Our observation match with that of Schissler et al who observed respiratory disease in 39.6% of admitted patients. 16 Singh et al in India observed similar frequency of hepatobiliary diseases (25.49%), infections (21.57%) and diabetes (3.92%). 17 AKI was observed in 104 (27.2%) patients in our settings.…”

Section: Discussionmentioning

confidence: 70%

Acute Kidney Injury; Frequency in Hospitalized Patients

Khan

Hassan

Khan

et al. 2017

TPMJ

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ABSTRACT… Objectives:To determine the frequency of acute kidney injury in hospitalized patients at Nishtar hospital, Multan. Study Design: Cross sectional study. Setting: Medical Unit-IV, Nishtar Hospital, Multan. Duration: Duration of study was 6 months from 17/07/2015 to 16/01/2016. Material and Methods: This study involved 383 patients of either sex aged between 37-60 years admitted to medical ward for various medical conditions. Results: The mean age of the patients was 48.96±7.24 years. There were 198 (51.7%) male and 185 (48.3%) female patients in the study group. The most frequent underlying cause requiring hospital admission was a respiratory tract disease observed in 153 (39.9%) patients. AKI was observed in 104 (27.2%) patients. When stratified the frequency of AKI increased significantly with increasing age of the patient; 37-42 years vs. 43-48 years vs. 49-54 years vs. 55-60 years (17.3% vs. 22.7% vs. 26.2% vs. 42.0%; p=.001). It was also significantly (p=.000) higher in patients with diabetes (47.4%) and hepatobiliary disease (34.7%) at admission followed by infections (26.4%) and respiratory tract diseases (17.6%). However, there was no significant difference in the frequency of AKI across genders; male vs. female (25.8% vs. 28.6%; p=.525). Conclusion: Very high frequency of acute kidney injury was observed in our study. Acute kidney injury was significantly associated with increasing age particularly more than 50 years and underlying medical conditions with particular reference to the diabetes mellitus and hepatobiliary diseases. Serial renal parameters monitoring should be adopted for early diagnosis followed by timely management of acute kidney disease. It will decrease associated disease morbidities and mortalities and will also improve quality of life of these patients.

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Characteristics and outcomes in community‐acquired versus hospital‐acquired acute kidney injury

Cited by 90 publications

References 26 publications

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

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

Risk for acute kidney injury in primary health care

Acute Kidney Injury; Frequency in Hospitalized Patients

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