Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired Acute Kidney Injury: A Meta-Analysis

Abstract

Background: The different clinical characteristics of community-acquired acute kidney injury (CA-AKI) versus hospital-acquired AKI (HA-AKI) have remained inconclusive, and thus, a meta-analysis was conducted to summarize and quantify the clinical significance distinguishing the 2 types of AKI. Methods: We identified observational studies reporting the clinical characteristics and prognosis of HA-AKI and CA-AKI. ORs and mean differences (MDs) were extracted for each outcome and the results aggregated. The primary outcome was defined as the mortality rate; renal recovery, oliguria incidence, dialysis, intensive care unit (ICU) requirement, and length of hospital stay were secondary outcomes. Results: Fifteen eligible studies involving 46,157 patients (22,791 CA-AKI patients and 23,366 HA-AKI patients) were included. Mortality was significantly lower in CA-AKI than in HA-AKI patients, with an OR of 0.43 (95% CI 0.35–0.53). The incidence of oliguria and need for ICU were also lower in CA-AKI patients (OR 0.58, 95% CI 0.38–0.88; OR 0.24, 95% CI 0.14–0.40, respectively). CA-AKI patients had a shorter hospital stay (MD –9.42, 95% CI –13.73 to –5.12). The renal recovery rate and dialysis need between CA- and HA-AKI were similar (OR 1.27, 95% CI 0.53–3.02; OR 1.05, 95% CI 0.82–1.34, respectively). Conclusions: CA-AKI showed better clinical manifestations with a lower incidence of oliguria, reduced risk of ICU treatment, and shorter hospital stay. Mortality associated with CA-AKI was lower compared with HA-AKI, indicating a better prognosis. The rate of renal recovery and need for dialysis showed no significant difference between the 2 groups.

Cross-site transportability of an explainable artificial intelligence model for acute kidney injury prediction

“…There are several limitations to our study. First, the definition of AKI depended on SCr changes in reference to patients' baseline SCr, which is not always observable (2/3 of AKI are community acquired 28 ). For patients without any SCr observed within 7 days prior to admission, we had to use their admission SCr as the baseline, which may underestimate the true AKI incidence.…”

Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

“…Fourthly, one must consider whether there are differences in the provenance of community-and hospital-acquired AKI that leads to a poorer outcome in hospital-acquired AKI patients, with iatrogenic and thrombotic disease being potential additional mechanisms in hospital-acquired AKI. Finally, pre-COVID-19 studies have shown that hospitalacquired AKI has significantly higher mortality than community-acquired AKI [18,19]. One suggested explanation was that all patients receive senior review on admission while senior review may be more sporadic during the inpatient stay.…”

“…For example, an AKI already present at the point of admission to hospital may have different pathophysiological drivers to one that occurs in a ventilated patient with a restrictive fluid management strategy. Pre-COVID-19 studies have indeed shown that risk factor profiles and outcomes are different for AKIs present on admission to hospital compared to those that develop during hospital admission [17][18][19]. We think this approach will be particularly informative in COVID-19 disease where there is a high propensity for iatrogenic kidney injury.…”

The Role of Renal Pathology in the Prognosis and Recovery of Community-Acquired Acute Kidney Injury

“…HA-AKI has been the focus of research over the last 2 decades; however, studies on CA-AKI have been thriving in recent years, showing that CA-AKI is as important a public health problem as HA-AKI, with a prevalence of 1.11% among adult hospitalizations, accounting for 54.4% of all AKI cases in a recent nationwide survey in China [12,13]. According to our latest meta-analysis, CA-AKI has a lower incidence of oliguria, reduced risk of ICU treatment, shorter hospital stay, and lower mortality than HA-AKI, whereas the rate of renal recovery and need for dialysis showed no significant difference between these 2 AKI subtypes [14]. Different from HA-AKI, causative factors of CA-AKI can be divided into prerenal azotemia, intrinsic renal disease and obstruction [15,16]; however, risk factors associated with renal prognosis after an episode of CA-AKI are still under debate.…”

“…Current AKI definitions and staging criteria are primarily derived from patients in the ICU, in whom the predominant spectrum of causes belongs to HA-AKI [2,6,32]. There are many differences between HA-AKI and CA-AKI with respect to epidemiology, clinical characteristics, and prognosis [14]. In this CA-AKI cohort, 70.4% (207/294) of patients had de novo intrinsic renal disease, except ATN or AIN, while only 5.1% (15/294) had a definitive previous history of chronic nephritis.…”