The influence of socioeconomic status on presentation and outcome of acute kidney injury

Phillips, Dafydd; Holmes, Jennifer; Davies, R. W.; Geen, John; Williams, Julie; Phillips, Aled Owain

doi:10.1093/qjmed/hcy180

Cited by 14 publications

(12 citation statements)

References 30 publications

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“…The centralized laboratory-based identification and alerting of AKI in Wales has allowed us to generate a national data set to provide characterization of the epidemiology of AKI in adults. [4][5][6][7][8][9][10][11] Our reported incidence of AKI is significantly higher than previously reported in children. 2,20,21 This likely reflects the methodological differences with a reliance on coding and a focus on hospitalized cases.…”

Section: Significance Of An Aki Alert Based On a Scr Value Within Thementioning

confidence: 62%

Acute Kidney Injury in Children Based on Electronic Alerts

Gubb

Holmes

Smith

et al. 2020

The Journal of Pediatrics

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Objective To define the incidence and outcome of acute kidney injury (AKI) in pediatrics using data collected from a national electronic alert system. Study design A prospective national cohort study was undertaken to collect data on all cases of pediatric AKI, excluding neonates, identified by an e-alert, from April 2015 to March 2019. Results There were 2472 alerts in a total of 1719 patients, giving an incidence of 77.3 per 100 000 person-years. Of the patients, 84.2% of all AKI were stage 1 and 58.3% occurred with a triggering creatinine within the reference range. The incidence of AKI was associated with measures of social deprivation. Thirty-day mortality was 1.7% but was significantly higher in hospital-acquired AKI (2.1%), compared with community-acquired AKI (0.8%, P < .001) and was associated with the severity of AKI at presentation. A significant proportion of patients had no repeat measure of creatinine (39.8%). This was higher in community-acquired AKI (69.7%) compared with hospital-acquired AKI (43.0%, P < .001), and higher in patients alerting with patients triggering with a creatinine within the reference range (48.4% vs 24.5%, P < .001). The majority of patients (84.7%) experienced only 1 AKI episode. Repeated episodes of AKI were associated with increased 30-mortaltiy (11.6% vs 4.6%, P < .001) and higher residual renal impairment (13.3% vs 5.4%, P < .001). Conclusions The results suggest that the significance of the alert is missed in many cases reflecting that a large proportion of cases represent modest elevations in serum creatinine (SCr), triggered by a SCr level that may be interpreted as being normal despite a significant increase from the baseline for the patient.

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Section: Significance Of An Aki Alert Based On a Scr Value Within Thementioning

confidence: 62%

Acute Kidney Injury in Children Based on Electronic Alerts

Gubb

Holmes

Smith

et al. 2020

The Journal of Pediatrics

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“…Interestingly the data also suggest that patients from socially deprived areas are at higher risk of recurrent episodes. Previously we have demonstrated that social deprivation is associated with higher incidence and worse outcome following AKI 25 . This was related to a greater burden of CKD at an earlier age.…”

Section: Discussionmentioning

confidence: 90%

Recurrent acute kidney injury: predictors and impact in a large population-based cohort

Holmes

Geen

Williams

et al. 2019

Nephrology Dialysis Transplantation

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Background This study examined the impact of recurrent episodes of acute kidney injury (AKI) on patient outcomes. Methods The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients ≥18 years of age between April 2015 and September 2018. Patients were grouped according to the number of AKI episodes they experienced with each patient’s first episode described as their index episode. We compared the demography and patient outcomes of those patients with a single AKI episode with those patients with multiple AKI episodes. Analysis included 153 776 AKI episodes in 111 528 patients. Results Of those who experienced AKI and survived their index episode, 29.3% experienced a second episode, 9.9% a third episode and 4.0% experienced fourth or more episodes. Thirty-day mortality for those patients with multiple episodes of AKI was significantly higher than for those patients with a single episode (31.3% versus 24.9%, P < 0.001). Following a single episode, recovery to baseline renal function at 30 days was achieved in 83.6% of patients and was significantly higher than for patients who had repeated episodes (77.8%, P < 0.001). For surviving patients, non-recovery of renal function following any AKI episode was significantly associated with a higher probability of a further AKI episode (33.4% versus 41.0%, P < 0.001). Furthermore, with each episode of AKI the likelihood of a subsequent episode also increased (31.0% versus 43.2% versus 51.2% versus 51.7% following a first, second, third and fourth episode, P < 0.001 for all comparisons). Conclusions The results of this study provide an important contribution to the debate regarding the need for risk stratification for recurrent AKI. The data suggest that such a tool would be useful given the poor patient and renal outcomes associated with recurrent AKI episodes as highlighted by this study.

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“…It is also possible that additional risk factors which were unavailable for these analyses, including ethnicity 45,46 and a history of acute kidney injury, may explain some of the relationships between socioeconomic of deprivation and advanced CKD. 47,48 Similarly, we did not have information on medication use, such as renin angiotensin aldosterone system inhibitors and anti-glycemic medications, which have an effect on the risk of CKD stage 4-5 and ESRD and could have acted differentially across the deprivation strata.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic disadvantage and the risk of advanced chronic kidney disease: results from a cohort study with 1.4 million participants

Weldegiorgis

Smith

Herrington

et al. 2019

Nephrology Dialysis Transplantation

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Background Several studies have investigated the effect of socioeconomic deprivation on cardiovascular disease (CVD) and diabetes; less is known about its effect on chronic kidney disease (CKD). We aimed to measure the association between deprivation, CKD Stages 4–5 and end-stage renal disease (ESRD) in a general population sample. Methods This observational study examined 1 405 016 participants from the English Clinical Practice Research Datalink (2000–14), linked to hospital discharge data and death certification. Deprivation was assessed according to the participant’s postcode. Cox models were used to estimate hazard ratios (HRs) for CKD Stages 4–5 and ESRD, adjusting for age and sex, and additionally for smoking status, body mass index, diabetes, systolic blood pressure, prior CVD and estimated glomerular filtration rate (eGFR) at baseline. Results During 7.5 years of median follow-up, 11 490 individuals developed CKD Stages 4–5 and 1068 initiated ESRD. After adjustment for age and sex, the HRs and confidence interval (CI) comparing those in the 20% most deprived of the population to the 20% least deprived were 1.76 (95% CI 1.68–1.84) and 1.82 (95% CI 1.56–2.12) for CKD Stages 4–5 and ESRD, respectively. Further adjustment for known risk factors and eGFR substantially attenuated these HRs. Adding our results to all known cohort studies produced a pooled relative risk of 1.61 (95% CI 1.42–1.83) for ESRD, for comparisons between highest to lowest categories of deprivation. Conclusion Socioeconomic deprivation is independently associated with an increased hazard of CKD Stages 4–5 and ESRD, but in large part may be mediated by known risk factors.

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The influence of socioeconomic status on presentation and outcome of acute kidney injury

Abstract: This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care.

Cited by 14 publications

References 30 publications

Acute Kidney Injury in Children Based on Electronic Alerts

Acute Kidney Injury in Children Based on Electronic Alerts

Recurrent acute kidney injury: predictors and impact in a large population-based cohort

Socioeconomic disadvantage and the risk of advanced chronic kidney disease: results from a cohort study with 1.4 million participants

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