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      Risk Factors for Community-Acquired Acute Kidney Injury in Medical Patients: A Nested Case-Control Study

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          Abstract

          Introduction: Research about the risk factors associated with community-acquired acute kidney injury (CA-AKI) in acute medical diseases is scarce. Data extrapolation from surgical to medical illnesses is questionable. Objectives: To evaluate potential risk factors and hospital outcomes associated with a CA-AKI in medical illnesses. Methods: We performed an unmatched nested case-control study from a previous prospective cohort study. We included adult patients with acute illnesses treated with internal medicine. Cases were defined as patients with a CA-AKI diagnosis upon hospital admission, and controls included patients from the same cohort who did not develop AKI during the first 5 days of hospitalisation. A logistic regression model was used to assess the association between potential risk factors and ­CA-AKI. Results: A total of 868 patients were included in the study (223 cases and 645 controls). The median age was 65 years (interquartile range 50–78). In a logistic regression model, the risk factors associated with CA-AKI included chronic kidney disease (CKD; OR 6.27; 95% CI 2.95–13.3, p < 0.001), ≥65 years old (OR 1.72; 95% CI 1.16–2.57, p = 0.007), acute bacterial infection (OR 1.95; 95% CI 1.36–2.80, p < 0.001), hypovolaemia (OR 1.88; 95% CI 1.32–2.69, p < 0.001), pre-hospital nephrotoxic drugs (OR 1.77; 95% CI 1.23–2.55, p = 0.002), anaemia (OR 1.49; 95% CI 1.03–2.14, p = 0.031) and systolic blood pressure (SBP) <107 mm Hg (OR 2.25; 95% CI 1.38–3.67, p = 0.001). A significant interaction between CKD and age was found ( p = 0.017) and included in the model (patients with CKD and ≥65 years old [OR 10.85; 95% CI 4.14–28.41, p < 0.001]). The area under the receiver operating characteristic curve of the final model was 0.743. Conclusions: CKD is strongly associated with CA-AKI upon hospital admission in medical illnesses patients. Older age enhances the risk of CA-AKI in patients with CKD. Other risk factors include pre-hospital nephrotoxic drugs, acute bacterial infection, anaemia, low SBP and hypovolaemia.

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          Author and article information

          Journal
          BPU
          Blood Purif
          10.1159/issn.0253-5068
          Blood Purification
          S. Karger AG
          0253-5068
          1421-9735
          2020
          November 2020
          22 April 2020
          : 49
          : 6
          : 677-684
          Affiliations
          aDepartment of Nephrology, Baxter Renal Care Services, Hospital Universitario Nacional de Colombia, Bogota, Colombia
          bDepartment of Nephrology, Fresenius Medical Express, Bogota, Colombia
          cDepartment of Internal Medicine, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogota, Colombia
          dDepartment of Physiological Sciences, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
          Author notes
          *Javier Enrique Cely, Department of Nephrology, Baxter Renal Care Services, Hospital Universitario Nacional de Colombia, Calle 44, 59-75, Bogota 111321 (Colombia), E-Mail javiercelynsd@hotmail.com
          Article
          506502 Blood Purif 2020;49:677–684
          10.1159/000506502
          32320978
          © 2020 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Figures: 1, Tables: 4, Pages: 8
          Categories
          Research Article

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