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2015 ; 131
(4
): 227-36
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Categories of Hospital-Associated Acute Kidney Injury: Time Course of Changes in
Serum Creatinine Values
#MMPMID26571483
Warnock DG
; Powell TC
; Donnelly JP
; Wang HE
Nephron
2015[]; 131
(4
): 227-36
PMID26571483
show ga
Hospital-associated acute kidney injury (HA-AKI) is associated with increased
inpatient mortality. Our objective was to categorize HA-AKI based on the timing
of minimum and peak inpatient serum creatinine (sCr) and describe the association
with inpatient mortality. MATERIALS AND METHODS: This study is a retrospective
analysis of an administrative data set for adults admitted to a single medical
center for over 4 years. Changes and timing of the minimum and peak sCr were used
to define HA-AKI categories. RESULTS: Peak creatinine followed minimum creatinine
for HA-AKI, and preceded the minimum value for transient HA-AKI (THA-AKI). A
subset of patients developed HA-AKI after recovering from THA-AKI. Multivariable
Cox regression analyses examined the association between these categories and
28-day inpatient mortality, adjusting for age, sex, race, Charlson comorbidity
index, baseline kidney function, AKI recovery and renal replacement therapy.
There were 50,601 patients included in the analyses, and 29,996 (59%) did not
have AKI. There were 2,440 deaths; HA-AKI had a 2.24-fold (95% CI 1.99-2.51)
increased risk, while THA-AKI group (12,101) had a 1.23-fold (95% CI 1.09-1.40)
increased risk for inpatient mortality. THA-AKI patients who recovered and then
developed HA-AKI had the same mortality risk as THA-AKI (1.27-fold [95% CI
1.07-1.51]) but longer hospitalization and less recovery from AKI. CONCLUSIONS:
Risk of short-term inpatient mortality is associated with AKI, and this risk is
attenuated with recovery of kidney function in the hospital. Systematic
surveillance with repeated inpatient sCr values is needed to assess the short-
and long-term consequences of HA-AKI.
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