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Risk Factors for Community-Acquired Acute Kidney Injury in Medical Patients: A Nested Case-Control Study.
Javier Enrique Cely1, Elkin José Mendoza2, John Jaime Sprockel3
1Department of Nephrology, Baxter Renal Care Services, Hospital Universitario Nacional de Colombia, Bogota, Colombia, javiercelynsd@hotmail.com.
Blood Purification
|April 23, 2020
Summary
Community-acquired acute kidney injury (CA-AKI) in medical patients is linked to chronic kidney disease (CKD), older age, infections, and dehydration. The risk is significantly higher for older patients with CKD.
Area of Science:
- Nephrology
- Internal Medicine
- Epidemiology
Background:
- Research on risk factors for community-acquired acute kidney injury (CA-AKI) in acute medical diseases is limited.
- Extrapolating data from surgical to medical conditions for CA-AKI risk factors is unreliable.
Purpose of the Study:
- To identify potential risk factors for CA-AKI in patients with acute medical illnesses.
- To evaluate hospital outcomes associated with CA-AKI in this patient population.
Main Methods:
- An unmatched nested case-control study was conducted using data from a prospective cohort.
- Adult patients with acute illnesses managed by internal medicine were included.
- Cases were defined as CA-AKI at admission; controls had no AKI within the first 5 days.
Main Results:
- Chronic kidney disease (CKD) was a significant risk factor for CA-AKI (OR 6.27).
- Older age (≥65 years), acute bacterial infection, hypovolemia, pre-hospital nephrotoxic drug use, anemia, and low systolic blood pressure (<107 mmHg) were also associated with CA-AKI.
- A significant interaction was found between CKD and older age, with a substantially increased OR (10.85) for CA-AKI.
Conclusions:
- CKD is a primary risk factor for CA-AKI upon hospital admission in medical patients.
- Older age amplifies the risk of CA-AKI in patients with pre-existing CKD.
- Other key risk factors include pre-hospital nephrotoxic drug exposure, acute bacterial infections, anemia, hypotension, and hypovolemia.
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