The significance of reduced kidney function among hospitalized acute general medical patients

Yong, Tuck Yean; Fok, Jie Shen; Ng, Pau; Hakendorf, Paul; Ben-Tovim, David I.; Roberts, Susan; Thompson, Campbell; Li, Jordan

doi:10.1093/qjmed/hcs192

Cited by 15 publications

(18 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, the characteristics of our selected patients were similar to those in the previous studies that included ICU patients. For example, in line with previous reports [21,31,32,33], the majority of our patients were elderly (24.7% were >80 years) with a high Charlson comorbidity score. The characteristics of our patients could be influenced by the criteria of ICU admission in our center, that is related to Apache II [34], and the fact that failure of kidney function is not considered a condition for admission.…”

Section: Discussionsupporting

confidence: 91%

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

View full text Add to dashboard Cite

Background: Epidemiological studies of acute kidney injury (AKI) have focused on patients admitted to intensive care units (ICUs), and several have studied hospitalized non-ICU patients, but analysis of patients referred to Nephrology is sparse. We analyzed factors associated with short- and long-term morbimortality among hospitalized non-ICU patients with AKI who were referred to Nephrology. Methods: A retrospective study with data prospectively collected from 170 non-ICU patients, with referral to the Nephrology Unit, recruited over a 4-year period, was performed. AKI was classified according to the criteria based on risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE). Risk factors that could influence prognosis of AKI and long-term mortality were analyzed at admission. Early on, 1- and 10-year mortalities were correlated with AKI RIFLE class, clinical and demographic characteristics. Results: Most patients were >65 years, with multiple comorbidities and frequent drug intake history. Median Charlson score was 6. Twenty-five percent of patients with previously unknown chronic kidney disease (CKD) were diagnosed with CKD during the study. Dialysis was required in 13.5% of patients. Hospital deaths were 22.4% and significantly associated with older age, RIFLE class L, higher peak serum creatinine, oliguria and decreased serum albumin levels. One-year (38.8%) and 10-year (68.8%) mortalities were significantly associated with age, prior cardiovascular disease, prior CKD and RIFLE class L. According to the Cox proportional hazard model, age, prior CKD and RIFLE class L were independent risk factors of death at 1 and 10 years. Conclusions: AKI in hospitalized non-ICU patients is associated with high early and late mortality. This study increases our understanding of AKI among this specific population and can improve their management.

show abstract

Section: Discussionsupporting

confidence: 91%

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

View full text Add to dashboard Cite

show abstract

“…Furthermore, clinicians frequently underreport the incidence of AKI in their patients with one study showing that discharge summaries reported renal insufficiency in only 13% of affected patients [76]. Population-based analyses vary widely between 140 and 2880 cases per million population yearly with a 400% increase between 1988 and 2002 [77–81].…”

Section: Epidemiology Of Akimentioning

confidence: 99%

Epidemiology of Acute Kidney Injury in the Intensive Care Unit

Case

Khan

Khalid

et al. 2013

Critical Care Research and Practice

261

223

View full text Add to dashboard Cite

The incidence of acute kidney injury (AKI) in the intensive care unit (ICU) has increased during the past decade due to increased acuity as well as increased recognition. Early epidemiology studies were confounded by erratic definitions of AKI until recent consensus guidelines (RIFLE and AKIN) standardized its definition. This paper discusses the incidence of AKI in the ICU with focuses on specific patient populations. The overall incidence of AKI in ICU patients ranges from 20% to 50% with lower incidence seen in elective surgical patients and higher incidence in sepsis patients. The incidence of contrast-induced AKI is less (11.5%–19% of all admissions) than seen in the ICU population at large. AKI represents a significant risk factor for mortality and can be associated with mortality greater than 50%.

show abstract

“…Previous studies have used administrative data to identify AKI and CKD . However, lack of coding and inconsistencies have been noted and another Australian study by Yong et al . reported that 87% of admissions with renal insufficiency were not coded.…”

Section: Discussionmentioning

confidence: 99%

“…This funding is known as case‐mix funding. It has previously been reported that up to 87% of admissions with renal insufficiency are not coded as having kidney failure …”

Section: Introductionmentioning

confidence: 99%

International statistical classification of diseases and related health problems coding underestimates the incidence and prevalence of acute kidney injury and chronic kidney disease in general medical patients

Venkatesan

Nand

et al. 2018

Internal Medicine Journal

View full text Add to dashboard Cite

Background The international classification of diseases (ICD) code is frequently used to identify renal impairment in epidemiological research. However, Australian studies examining accuracy of this administrative data in coding kidney injury are lacking. Aims To compare the ICD 10 coding with the kidney disease: improving global outcomes (KDIGO) criteria in diagnosing acute kidney injury (AKI) and/or chronic kidney disease (CKD). Methods A retrospective study of 325 patients admitted to general medicine during January 2012 was performed. Sensitivity and specificity of ICD 10 in identifying AKI and CKD were calculated using KDIGO as gold standard. Results The sensitivities of ICD 10 in identifying AKI and CKD were low for both (59.5% and 54.1%), but the specificities were high (86.2% and 90.2%). Using KDIGO criteria, we identified 72 AKI (22%), 56 CKD (17%), 64 AKI on CKD (19%) and 133 controls (40%). Compared to the control group, patients with AKI and AKI on CKD had longer length of stay (3.2 vs 4.9 days and 3.2 vs 4.8 days, P = 0.20). Renal impairment groups had increased in‐hospital mortality rate (5% control, 6% AKI, 10% CKD, 9% AKI on CKD) and re‐admission rate within 30 days (13% control, 20% AKI, 25% CKD, 26% AKI on CKD). After adjusting for age, gender and comorbidities, the difference in outcomes was not statistically significant. Conclusion This study shows that ICD 10 fails to identify almost half of the patients with AKI (40.5%) and CKD (45.9%) in our cohort. A total of 60% had evidence of renal impairment as defined by KDIGO.

show abstract

The significance of reduced kidney function among hospitalized acute general medical patients

Cited by 15 publications

References 26 publications

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Epidemiology of Acute Kidney Injury in the Intensive Care Unit

International statistical classification of diseases and related health problems coding underestimates the incidence and prevalence of acute kidney injury and chronic kidney disease in general medical patients

Contact Info

Product

Resources

About