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Community-Acquired Acute Kidney Injury: A Nationwide Survey in China.

Research paper by Yafang Y Wang, Jinwei J Wang, Tao T Su, Zhen Z Qu, Minghui M Zhao, Li L Yang,

Indexed on: 25 Jan '17Published on: 25 Jan '17Published in: American Journal of Kidney Diseases



Abstract

This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI.Cross-sectional and retrospective study.A national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission.The rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted.All-cause in-hospital mortality and recovery of kidney function at hospital discharge.4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor.Possible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine.The features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources.