Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury

Hsu, Chien‐Ning; Lee, Chien-Te; Su, Chien-Hao; Wang, Yu-Ching Lily; Chen, Hsiao‐Ling; Chuang, Jiin‐Haur; Tain, You‐Lin

doi:10.1097/md.0000000000003674

Cited by 76 publications

(85 citation statements)

References 29 publications

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“…Short-and long-term mortality is increased in CA H -AKI [1,8] although HA-AKI is more likely to result in death [3,10,11] . Talabani et al [5] reported 45% 3-year mortality for CA H -AKI compared to 15.7% ( p < 0.01) in the control cohort with similar figures reported at 5 years (44.6% in Soto et al [7] ).…”

Section: Resultsmentioning

confidence: 99%

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Emmett

Tollitt

McCorkindale

et al. 2017

Nephron

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Background: Almost two-thirds of patients with acute kidney injury (AKI) damage their kidneys whilst in the community. This paper aims to review existing data on incidence, mortality, and morbidity of AKI within the community and explore the evidence base for primary care strategies aimed at reducing incidence and improving early detection and management of AKI. Methods: A literature search was carried out using PubMed; key words including AKI, primary care, community acquired, and electronic alerts (e-alerts) were used to capture relevant data. Results: Incidence of AKI developing in the community is variable between studies due to differences in AKI definition. Community-acquired AKI (CA-AKI) but identified in hospital (CA_H-AKI) is more prevalent than hospital-acquired AKI and increases short- and long-term mortality and length of stay in hospital. CA-AKI identified in primary care is less severe than CA_H-AKI but is associated with increased mortality. The use of e-alerts has good diagnostic accuracy for detecting AKI but their impact on outcomes in secondary care remains uncertain; it is likely that they should be complemented with other interventions to improve management. Evidence has not yet emerged regarding the effects of e-alerts on outcomes in primary care. Conclusion: Given the significance of developing AKI in the community, strategies to aid early detection and promote prevention are warranted. A multifaceted approach combining e-alerts, educational programs, and care bundles across the interface between primary and secondary care has the potential to improve outcomes in the future.

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Section: Resultsmentioning

confidence: 99%

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Emmett

Tollitt

McCorkindale

et al. 2017

Nephron

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“…Even as a relatively new study concept, several risk factors for CA-AKI have been identified, many of which are reflective of those for HA-AKI, such as age, diabetes, congestive HF, CKD, human immunodeficiency virus, obstructive uropathy, and volume depletion [1, 9]. Patients with CA-AKI are more likely to have comorbidities than patients with HA-AKI [17]. The most common etiology of CA-AKI is typically prerenal, such as gastrointestinal loss, poor intake, and/or medications such as nonsteroidal anti-inflammatory drugs, diuretics, and/or angiotensin-converting enzyme inhibitors [18].…”

Section: Discussionmentioning

confidence: 99%

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Tecson¹,

Hashemi²,

Afzal³

et al. 2019

Cardiorenal Med

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Objectives: Because patients with hospital-acquired acute kidney injury (AKI) are at risk for subsequent development of heart failure (HF) and little is known about the relation between community-acquired AKI (CA-AKI) and HF, we sought to determine if CA-AKI is a risk factor for incident HF hospitalization. Methods: We utilized Baylor Scott & White Health databases at the primary care and inpatient hospitalization levels to identify adults without a prior history of HF who had 2 or more serum creatinine measurements within 13 months in the primary care setting. We defined CA-AKI as a serum creatinine increase ≥0.3 mg/dL or ≥1.5 times the baseline for consecutive values within a 13-month period. We created a flag for de novo HF hospitalization at 90, 180, and 365 days following CA-AKI evaluation. Results: In the analyses, 210,895 unique adults were included, of whom 5,358 (2.5%) had CA-AKI. Those with CA-AKI had higher rates of comorbidities, higher rate of males (48 vs. 42%, p < 0.001), and were older (61.5 [50.3, 73.1] vs. 54.1 [42.8, 64.7] years, p < 0.001) than those who did not have CA-AKI. In total, 607 (0.3%), 833 (0.4%), and 1,089 (0.5%) individuals had an incident HF hospitalization in the 90, 180, and 365 days following the CA-AKI evaluation, respectively. After adjusting for demographic and clinical characteristics, patients with CA-AKI had >2 times the risk of de novo HF hospitalization compared with patients who did not have CA-AKI (90 days: 2.35 [1.83–3.02], p < 0.001; 180 days: 2.52 [2.04–3.13], p < 0.001; 365 days: 2.16 [1.77–2.64], p < 0.001). These multivariable models yielded strong predictive abilities, with the areas under the receiver-operating characteristic curve >0.90. Conclusion: After controlling for baseline and clinical characteristics, patients with CA-AKI were at approximately twofold the risk of de novo HF hospitalization (within 90, 180, and 365 days) compared with those who did not have CA-AKI. Hence, detecting CA-AKI may provide an opportunity for early intervention at the primary care level to possibly delay HF development.

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“…While numerous studies have focused on the epidemiology and clinical outcomes of patients who developed AKI during hospitalization—hospital‐acquired (HA)‐AKI—little is known about community‐acquired (CA)‐AKI (before hospitalization); nine studies have examined it . CA‐AKI was actually about two to four times more common than HA‐AKI.…”

Section: Epidemiology Of Akimentioning

confidence: 99%

“…Five studies investigated the need for acute dialysis in patients with CA‐AKI and HA‐AKI . All but one study showed that HA‐AKI patients were twice as likely to need acute dialysis.…”

Section: Epidemiology Of Akimentioning

confidence: 99%

Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies

Negi

Koreeda

Kobayashi

et al. 2018

Seminars in Dialysis

106

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Acute kidney injury (AKI) is one of the most common serious complications for all hospital admissions, with its incidence increasing among hospitalized patients, particularly those in the intensive care unit. Despite significant improvements in critical care and dialysis technology, AKI is associated with an increased risk of short- and long-term mortality, prolonged hospital stays, and dialysis dependence. These risks are particularly relevant for critically ill patients with AKI severe enough to require renal replacement therapy (RRT). No specific pharmacologic treatment has been established to treat AKI. Hence, the mainstay treatment for patients with AKI is RRT even though there are still several problematic issues regarding its use including RRT modality, dose, and timing. Recently, the impact of AKI on an increased risk of progression to chronic kidney disease (CKD) and end-stage renal disease requiring dialysis or transplantation is attracting increased attention.

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Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury

Abstract: Supplemental Digital Content is available in the text

Cited by 76 publications

References 29 publications

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies

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