Epidemiology and Outcomes of Acute Renal Failure in Hospitalized Patients

Abstract

The aim of this study was to provide a broad characterization of the epidemiology of acute renal failure (ARF) in the United States using national administrative data and describe its impact on hospital length of stay (LOS), patient disposition, and adverse outcomes. Using the 2001 National Hospital Discharge Survey, a nationally representative sample of discharges from nonfederal acute care hospitals in the United States, new cases of ARF were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Multivariate regression analyses were used to explore the relation of ARF to hospital LOS and mortality as well as discharge disposition. Review of discharge data on a projected total of 29,039,599 hospitalizations identified 558,032 cases of ARF, with a frequency of 19.2 per 1000 hospitalizations. ARF was more commonly coded for in older patients; men; black individuals; and the setting of chronic kidney disease, congestive heart failure, chronic lung disease, sepsis, and cardiac surgery. ARF was associated with an adjusted prolongation of hospital LOS by 2 d (P < 0.001) and an adjusted odds ratio of 4.1 for hospital mortality and of 2.0 for discharge to short-or long-term care facilities. In a US representative sample of hospitalized patients, the presence of an ICD-9-CM code for ARF in discharge records is associated with prolonged LOS, increased mortality, and, among survivors, a greater requirement for posthospitalization care. These findings suggest that in the United States, ARF is associated with increased in-hospital and post-hospitalization resource utilization.

Diagnostics in anaemia of chronic disease in general practice: a real-world retrospective cohort study

“…In this study, the most common underlying causes of ACD were infections, autoimmune inflammation, and malignancies; this is in line with data from hospitalised patients with ACD. 4,25,26 However, compared with the present study population, a markedly higher prevalence of renal insufficiency was reported among hospitalised patients with ACD. 3,25 This might be due to selection bias in the present study population; the transmural project separated renal anaemia as a distinct category of anemia, resulting in less renal insufficiency in this ACD patient group.…”

Quantitative assessment of acute kidney injury by noninvasive arterial spin labeling perfusion MRI: a pilot study

“…AKI refers to a clinical syndrome characterized by rapid decreases in renal function within a few hours to a few days, with accumulation of products of nitrogen metabolism such as creatinine and urea [10]. Causes of AKI vary from reduced kidney perfusion and prerenal azotemia to direct renal toxicity and postrenal obstruction, with AKI accounting for 1.9% of hospital inpatients [27]. Although increased serum creatinine and urea concentrations are the standard diagnostic laboratory criteria for AKI, they are relatively insensitive, becoming abnormal only when glomerular filtration rate decreases by more than 50%.…”

Renal Biopsies in Acute Kidney Injury

“…This is especially true with regards to acute kidney injury (AKI). AKI is a common entity in the hospital setting (1), even given the problems of definition and terminology that have recently received attention (2), and its causes are highly dependent on the population studied. Despite its enormous clinical impact, there have been few series of renal histology data published on the etiologies leading to AKI.…”