Epidemiology of AKI: Utilizing Large Databases to Determine the Burden of AKI

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Abstract

Large observational databases linking kidney function and other routine patient health data are increasingly being used to study acute kidney injury (AKI). Routine health care data show an apparent rise in the incidence of population AKI and an increase in acute dialysis. Studies also report an excess in mortality and adverse renal outcomes after AKI, although with variation depending on AKI severity, baseline, definition of renal recovery, and the time point during follow-up. However, differences in data capture, AKI awareness, monitoring, recognition, and clinical practice make comparisons between health care settings and periods difficult. In this review, we describe the growing role of large databases in determining the incidence and prognosis of AKI and evaluating initiatives to improve the quality of care in AKI. Using examples, we illustrate this use of routinely collected health data and discuss the strengths, limitations, and implications for researchers and clinicians.

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Most cited references 54

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Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

Glenn Chertow, Elisabeth Burdick, Melissa M Honour … (2005)

The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.

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Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001.

Jay L Xue, Frank Daniels, Robert Star … (2006)

This study's objective was to determine the incidence and mortality of acute renal failure (ARF) in Medicare beneficiaries. Data were from hospitalized Medicare beneficiaries (5,403,015 discharges) between 1992 and 2001 from the 5% sample of Medicare claims. For 1992 to 2001, the overall incidence rate of ARF was 23.8 cases per 1000 discharges, with rates increasing by approximately 11% per year. Older age, male gender, and black race were strongly associated (P < 0.0001) with ARF. The overall in-hospital death rate was 4.6% in discharges without ARF, 15.2% in discharges with ARF coded as the principal diagnosis, and 32.6% in discharges with ARF as a secondary diagnosis. In-hospital death rates were 32.9% in discharges with ARF that required renal dialysis and 27.5% in those with ARF that did not require dialysis. Death within 90 d after hospital admission was 13.1% in discharges without ARF, 34.5% in discharges with ARF coded as the principal diagnosis, and 48.6% in discharges with ARF as a secondary diagnosis. Discharges with ARF were more (P < 0.0001) likely to have intensive care and other acute organ dysfunction than those without ARF. For discharges both with and without ARF, rates for death within 90 d after hospital admission showed a declining trend. In conclusion, the incidence rate of ARF in Medicare beneficiaries has been increasing. Those of older age, male gender, and black race are more likely to have ARF. These data show ARF to be a major contributor to morbidity and mortality in hospitalized patients.

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Acute kidney injury associates with increased long-term mortality.

Jean-Philippe Lafrance, Donald Miller (2010)

Acute kidney injury (AKI) associates with higher in-hospital mortality, but whether it also associates with increased long-term mortality is unknown, particularly after accounting for residual kidney function after hospital discharge. We retrospectively analyzed data from US veteran patients who survived at least 90 d after discharge from a hospitalization. We identified AKI events not requiring dialysis from laboratory data and classified them according to the ratio of the highest creatinine during the hospitalization to the lowest creatinine measured between 90 d before hospitalization and the date of discharge. We estimated mortality risks using multivariable Cox regression models adjusting for demographics, comorbidities, medication use, primary diagnosis of admission, length of stay, mechanical ventilation, and postdischarge estimated GFR (residual kidney function). Among the 864,933 hospitalized patients in the study cohort, we identified 82,711 hospitalizations of patients with AKI. In the study population of patients who survived at least 90 d after discharge, 17.4% died during follow-up (AKI 29.8%, without AKI 16.1%). The adjusted mortality risk associated with AKI was 1.41 (95% confidence interval [CI] 1.39 to 1.43) and increased with increasing AKI stage: 1.36 (95% CI 1.34 to 1.38), 1.46 (95% CI 1.42 to 1.50), and 1.59 (95% CI 1.54 to 1.65; P < 0.001 for trend). In conclusion, AKI that does not require dialysis associates with increased long-term mortality risk, independent of residual kidney function, for patients who survive 90 d after discharge. Long-term mortality risk is highest among the most severe cases of AKI.

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Author and article information

Contributors

Simon Sawhney

Journal

Journal ID (nlm-ta): Adv Chronic Kidney Dis

Journal ID (iso-abbrev): Adv Chronic Kidney Dis

Title: Advances in Chronic Kidney Disease

Publisher: W.B. Saunders

ISSN (Print): 1548-5595

ISSN (Electronic): 1548-5609

Publication date PMC-release: 1 July 2017

Publication date (Print): July 2017

Volume: 24

Issue: 4

Pages: 194-204

Affiliations

[1]Kidney Disease@Farr Collaboration, University of Aberdeen, Aberdeen, UK; and Kidney Disease@Farr Collaboration, University of Southampton, Southampton, UK

Author notes

[∗ ]Address correspondence to Simon Sawhney, MBChB, Institute of Applied Health Sciences, University of Aberdeen, Room 1:014 Polwarth Building, Aberdeen, AB25 2ZD, UK.Institute of Applied Health SciencesUniversity of AberdeenRoom 1:014 Polwarth BuildingAberdeenAB25 2ZDUK simon.sawhney@ 123456abdn.ac.uk

Article

Publisher ID: S1548-5595(17)30078-2

DOI: 10.1053/j.ackd.2017.05.001

PMC ID: 5648688

PubMed ID: 28778358

SO-VID: c5ae0a31-a13f-434b-af4f-7d6f7ccbc21a

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This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Epidemiology of AKI: Utilizing Large Databases to Determine the Burden of AKI

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Most cited references 54

Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001.

Acute kidney injury associates with increased long-term mortality.

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