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Hospital-acquired renal insufficiency
Kevin Nash1, Abdul Hafeez, Susan Hou
1Evanston Hospital, Evanston, IL, USA.
Summary
Hospital-acquired renal insufficiency (HARI) affects 7.2% of patients, often due to decreased perfusion or medications. While mortality is high, especially with sepsis, survival trends are improving.
Area of Science:
- Nephrology
- Internal Medicine
- Critical Care
Background:
- Declining renal function is a frequent complication in hospitalized patients despite medical advancements.
- Acute kidney injury (AKI) incidence is rising with increasing hospital admission acuity.
Purpose of the Study:
- To prospectively evaluate the incidence, causes, risk factors, and outcomes of hospital-acquired renal insufficiency (HARI).
- To identify patient populations at higher risk for HARI and assess mortality trends.
Main Methods:
- Prospective follow-up of renal function in 4,622 consecutive medical and surgical admissions.
- Identification of causes including decreased renal perfusion, medications, surgery, and contrast media.
- Analysis of mortality rates based on serum creatinine increase and specific causes like sepsis.
Main Results:
- 7.2% of patients developed some degree of renal insufficiency.
- Common causes included decreased renal perfusion, medications, surgery, and contrast media.
- Overall mortality was 19.4%, significantly higher (37.8%) with a >3.0 mg/dL serum creatinine increase.
- Age and pre-existing renal insufficiency were risk factors; women and Black patients had less HARI.
- A trend toward better survival was observed in patients with severe renal function deterioration.
Conclusions:
- HARI is a significant complication in hospitalized patients, associated with substantial mortality.
- Identifying risk factors and common causes is crucial for prevention and management strategies.
- Despite the risks, there are encouraging trends in survival for critically ill patients with renal failure.