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

Abstract

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.

Glomerular disease and acute kidney injury in Sudan: Demographics, histological diagnosis and outcome

“…This is in contrast to studies from the developed world in which milder stages of AKI predominate. [22,23] This may suggest that renal diseases in the developed world present to medical services at later stages, which may in part be related to a lack of appreciation of risk in this geographical setting. [24] This pattern of late presentation has also been seen in the context of CKD in SSA and is likely to reflect accessibility to healthcare services in the region.…”

Recognition and management of acute kidney injury

“…More generally, data indicate that following an episode of AKI, patients may be at increased risk of mortality, development or progression of CKD and readmission to hospital, 6 suggesting that an episode of AKI may imply vulnerability, and patient care may need to be individualised to address this.…”

“…6 As a result, AKI may have the potential to act as a barometer of safety in patient care delivered across the interfaces between primary and secondary care.…”

Automatic detection of acute kidney injury episodes from primary care data

“…occur outside hospitals, and therefore while the patient is under primary care [11]. Given the better short-and long-term outcomes, including reduced mortality, for patients with community acquired AKI [11], [12], robust detection of AKI within a primary care setting could substantially improve patient outcomes.…”