Acute kidney injury burden in different clinical units: Data from nationwide survey in China

PLoS One. 2017 Feb 2;12(2):e0171202. doi: 10.1371/journal.pone.0171202. eCollection 2017.

Abstract

Background: The inpatient morbidity and mortality of acute kidney injury (AKI) vary considerably in different clinical units, yet studies to compare the difference remain limited.

Methods: We compared the clinical characteristics of AKI in Intensive Care Unit (ICU), medical and surgical departments by using the data derived from the 2013 nationwide cross-sectional survey of AKI in China to capture variations among different clinical departments in recognition, management, and outcomes of AKI. Suspected AKI patients were identified based on changes in serum creatinine during hospitalization, and confirmed by reviewing medical records.

Results: The detection rate of AKI was the highest in ICU (22.46%), followed by the rates in medical (1.96%) and surgical departments (0.96%). However, the absolute number of cases was the largest in medical departments, which contributed to 50% of the cases. In medical departments, 78% of AKI cases were extensively distributed in cardiac, nephrology, oncology, gastroenterology, pneumology and neurology departments. In contrast, 87% of AKI cases in surgical departments were mainly from urology, general surgery and cardiothoracic departments. The in-time recognition rates were extremely low in all departments except nephrology. Only 10.5~15.0% AKI patients from non-nephrology departments received renal referral. Among all the death cases, 50% and 39% came from ICU and medical departments while only 11% from surgical departments. Older age, higher AKI stage and renal replacement therapy indication were identified as risk factors for high mortality in all departments. Delayed recognition and no renal referral were significantly associated with increased mortality in medical and ICU patients.

Conclusions: These findings suggest that ICU and medical departments are major affected departments in China with a large number of AKI cases and subsequent high mortality. The reality is more alarming considering the low awareness of AKI and the paucity of effective interventions in the high-risk patients in these departments.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / mortality
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • China / epidemiology
  • Cost of Illness
  • Creatinine / blood
  • Cross-Sectional Studies
  • Female
  • Hospital Departments / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Risk Factors
  • Young Adult

Substances

  • Creatinine

Grant support

This study was supported by Major Fundamental Research Program of Shanghai Committee of Science and Technology (12DJ1400300, CM); Shanghai Top Priority Key Clinical Disciplines Construction Project (CM); Key Projects in the National Science & Technology Pillar Program in the Twelfth Five-year Plan Period (2011BAI10B07, SY), National Nature Science Fund of China (No. 81500533) and International Society of Nephrology Research Committee (LY). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.