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2016 ; 95
(19
): e3674
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Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired
Acute Kidney Injury: A Retrospective Cohort Study
#MMPMID27175701
Hsu CN
; Lee CT
; Su CH
; Wang YL
; Chen HL
; Chuang JH
; Tain YL
Medicine (Baltimore)
2016[May]; 95
(19
): e3674
PMID27175701
show ga
The disease burden and outcomes of community-acquired (CA-) and hospital-acquired
acute kidney injury (HA-AKI) are not well understood. The aim of the study was to
investigate the incidence, outcomes, and risk factors of AKI in a large Taiwanese
adult cohort.This retrospective cohort study examined 734,340 hospital admissions
from a group of hospitals within an organization in Taiwan between January 1,
2010 and December 31, 2014. Patients with AKI at discharge were classified as
either CA- or HA-AKI based on the RIFLE (risk, injury, failure, loss of function,
end stage of kidney disease) classification criteria. Outcomes were in-hospital
mortality, dialysis, recovery of renal function, and length of stay. Risks of
developing AKI were determined using multivariate logistic regression based on
demographic and baseline clinical characteristics and nephrotoxin use before
admission.AKI occurred in 1.68% to 2% hospital discharges among adults without
and with preexisting chronic kidney disease (CKD), respectively. The incidence of
CA-AKI was 17.25 and HA-AKI was 8.14 per 1000 admissions. The annual rate of
CA-AKI increased from 12.43 to 19.96 per 1000 people, but the change in HA-AKI
was insignificant. Comparing to CA-AKI, those with HA-AKI had higher levels of
in-hospital mortality (26.07% vs 51.58%), mean length of stay (21.25?±?22.35 vs
35.84?±?34.62 days), and dialysis during hospitalization (1.45% vs 2.06%).
Preexisting systemic diseases, including CKD were associated with increased risks
of CA-AKI, and nephrotoxic polypharmacy increased risk of both CA- and
HA-AKI.Patients with HA-AKI had more severe outcomes than patients with CA-AKI,
and demonstrated different spectrum of risk factors. Although patients with
CA-AKI with better outcomes, the incidence increased over time. It is also clear
that optimal preventive and management strategies of HA- and CA-AKI are urgently
needed to limit the risks in susceptible individuals.