P0566incidence and Impact of Acute Kidney Injury (Aki) in Andalusia

Abstract

Background and Aims Acute Kidney Injury (AKI) is an insufficiently reported clinical entity with significant impact on overall mortality, hospital stay and associated costs, increasing the risk of progression to Chronic Kidney Disease. It is especially relevant in hospitalized patients, where the incidence has doubled in the last decade, reaching 22-25%. Aims: Know the reported incidence of AKI in the Andalusian Autonomous Community, and its impact on mortality, average stay and associated costs. Method Cross-sectional descriptive study that analyzes data from all Andalusian hospitals, extracted from CMBDA corresponding to 2017. Hospitalization episodes, reference units, episodes with AKI at discharge, exitus and average stays were collected. An associated cost estimate analysis was also carried out using as reference the costs/day hospitalization in each SAS Assistance Unit according to BOJA Number 218 (14nov2016). The groups were compared according to the presence of the diagnosis of AKI. Results There were 525,757 hospital admissions in Andalusia; 25,727 reported the diagnosis of AKI at discharge, assuming an incidence of 4.89%. Patients with AKI total 316,938 stays, with an average stay of 15.5 + 13.8 days, compared to 6.5 + 6 days in which they have no associated diagnosis (p <0.01). The estimated costs associated with the diagnosis of AKI were 168,922,706 euros, with a cost / episode of 24,693 euros vs 3796 in the rest (p <0.01) (AKI/noAKI cost ratio: 6.5), and a cost / day / patient of 823 + 437 euros for AKI compared to 571 euros in the rest. The overall mortality associated with AKI was 26.8% (median 16.6%) vs. 4.76% (median 0.7%) in the rest (p <0.01). AKI/noAKI mortality ratio: 16. These data may be underestimated since the completion of the CMBDA is not complete in all hospitals and also the diagnosis of AKI may have been present and not reported upon discharge. Estimated costs did not include dialysis sessions. Conclusion The incidence of hospital AKI in our Autonomous Community is lower than that reported in the literature, probably due to inadequate reporting to CMBD. In spite of the limitations, our data show the impact of the diagnosis of AKI in hospitalized patients, multiplying by 2.5 the average stay, by 6.5 the associated costs and by 16 mortality, assuming a big problem Public Health that makes it imperative to develop measures to reduce the impact it entails.