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

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          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

          Blood Purif
          Blood Purification
          S. Karger AG
          November 2020
          22 April 2020
          : 49
          : 6
          : 677-684
          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
          506502 Blood Purif 2020;49:677–684
          © 2020 S. Karger AG, Basel

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


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