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Published on: July 17, 2016
Epidemiology and outcome of community-acquired acute kidney injury
Bnar Talabani1, Soha Zouwail, Rhodri D Pyart
1Insititute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
Insights
Community-acquired acute kidney injury (CA-AKI) affects older individuals and is linked to chronic kidney disease. CA-AKI significantly increases the risk of progressive kidney disease and long-term mortality.
Area of Science:
- Nephrology
- Internal Medicine
- Critical Care Medicine
Background:
- Limited data exist on community-acquired acute kidney injury (CA-AKI).
- Understanding CA-AKI's impact on renal function and mortality is crucial.
Purpose of the Study:
- To identify and characterize a patient cohort with CA-AKI.
- To document the short-term and long-term outcomes of CA-AKI.
Main Methods:
- Retrospective analysis of CA-AKI patients identified from a health board database over one month in 2009.
- Follow-up data collected for up to three years to assess renal function and mortality.
- Comparison with age/sex-matched control groups.
Main Results:
- CA-AKI patients were older (70.3 years) with a male predominance (61%).
- Pre-existing chronic kidney disease (CKD) was more common in CA-AKI patients (38%).
- 3-month mortality was 16.5%, and 3-year mortality was 45%. 71% developed progressive CKD within 3 years.
Conclusions:
- CA-AKI is associated with significant long-term renal disease progression.
- CA-AKI carries a high risk of long-term patient mortality.
- Early identification and management of CA-AKI are vital.
Aims:
Very little data exist regarding community-acquired acute renal injury (CA-AKI). We have identified and characterized a patient cohort with CA-AKI, and documented its impact on renal function and patient mortality.
Methods:
Using the database of the Medical Biochemistry Department of the Cardiff and Vale University Health Board we identified all patients with CA-AKI over a 1 month period in 2009. Follow-up biochemical and clinical data were used to determine short-term (3 months) and long-term (3 years) outcomes. Comparisons were made to a random and an age/sex matched group.
Results:
Patients with CA-AKI were older than a non-AKI cohort (70.3 vs 57.1 years; P < 0.0001), with a 61% male predominance. 38% had pre-existing chronic kidney disease (CKD) compared with 25% in the age- and sex-matched non-CA-AKI cohort (P = 0.007). 54% of CA-AKI were admitted for inpatient care. Admission was associated with a higher incidence of complete recovery of renal function. Mortality at 3 months was 16.5%, and was related to the severity of AKI. Over the 3 years of follow-up 71% of patients with CA-AKI developed progressive CKD which was more likely following incomplete/no recovery of renal function and in the context of pre-existing CKD. Three year mortality was 45%, which was higher than that of the age/sex matched control cohort (15.7%; P < 0.0001), but was not related to the development of progressive CKD.
Conclusions:
CA-AKI carries significant implications in terms of both development of progressive renal disease and high long-term patient mortality.
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