Hospital-acquired acute kidney injury and hospital readmission: a cohort study

Am J Kidney Dis. 2015 Feb;65(2):275-82. doi: 10.1053/j.ajkd.2014.08.024. Epub 2014 Oct 22.

Abstract

Background: Hospital-acquired acute kidney injury (AKI) is associated with increased mortality and resource consumption. Little is known about the association of AKI with short-term hospital readmissions.

Study design: Retrospective cohort study.

Setting & participants: We investigated whether adult survivors of hospital-acquired AKI were at increased odds for early hospital readmission.

Predictor: The peak-to-nadir serum creatinine difference during the index hospitalization was used to define AKI according to the KDIGO (Kidney Disease: Improving Global Outcomes) classification and staging system.

Measurements: Multivariable logistic regression analyses examined the association of AKI with 30-, 60-, and 90-day hospital readmission, adjusting for age, sex, race, Charlson-Deyo comorbidity index score, acute hospital-related factors, common causes of hospitalization, and baseline estimated glomerular filtration rate.

Results: 3,345 (15%) of 22,001 included patients experienced AKI during the index hospitalization. Compared to the non-AKI group, the AKI group had a significantly higher 30-day hospital readmission rate (11% vs 15%; P<0.001), which persisted at 60 and 90 days. The AKI group also was more likely to be readmitted to the hospital within 30 days for cardiovascular-related conditions, mainly heart failure (P<0.001) and acute myocardial infarction (P=0.01). AKI associated independently with higher odds of 30-day hospital readmission (OR, 1.21; 95% CI, 1.08-1.36), which persisted at 60 (OR, 1.15; 95% CI, 1.03-1.27) and 90 days (adjusted OR, 1.13; 95% CI, 1.02-1.25). Results were attenuated in a propensity score-matched cohort of 5,912 patients.

Limitations: Single-center study of mild forms of AKI; ascertainment bias and outcome misclassification due to the use of administrative codes.

Conclusions: Our results suggest that survivors of hospital-acquired AKI experience higher odds of early hospital readmission. Transitions of care services may be warranted for such patients to prevent readmissions and reduce health care costs.

Keywords: Acute kidney injury (AKI); acute renal failure (ARF); care transition; hospital-acquired; re-hospitalization; readmission.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / epidemiology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Hospitalization / trends
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission / trends*
  • Retrospective Studies
  • Tertiary Care Centers / trends*