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Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals.
Clin J Am Soc Nephrol 2014; 9(1):12-20CJ

Abstract

BACKGROUND AND OBJECTIVES

At least four definitions of AKI have recently been proposed. This study sought to characterize the epidemiology of AKI according to the most recent consensus definition proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group, and to compare it with three other definitions.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This was a retrospective cohort study of 31,970 hospitalizations at an academic medical center in 2010. AKI was defined and staged according to KDIGO criteria, the Acute Dialysis Quality Initiative's RIFLE criteria, the Acute Kidney Injury Network (AKIN) criteria, and a definition based on a model of creatinine kinetics (CK). Outcomes of interest were incidence, in-hospital mortality, length of stay, costs, readmission rates, and posthospitalization disposition.

RESULTS

AKI incidence was highest according to the KDIGO definition (18.3%) followed by the AKIN (16.6%), RIFLE (16.1%), and CK (7.0%) definitions. AKI incidence appeared markedly higher in those with low baseline serum creatinine according to the KDIGO, AKIN, and RIFLE definitions, in which AKI may be defined by a 50% increase over baseline. AKI according to all definitions was associated with a significantly higher risk of death and higher resource utilization. The adjusted odds ratios for in-hospital mortality in those with AKI were highest with the CK definition (5.2; 95% confidence interval [95% CI], 4.1 to 6.6), followed by the RIFLE (2.9; 95% CI, 2.2 to 3.6), KDIGO (2.8; 95% CI, 2.2 to 3.6), and AKIN (2.6; 95% CI, 2.0 to 3.3) definitions. Concordance in diagnosis and staging was high among the KDIGO, AKIN, and RIFLE definitions.

CONCLUSIONS

The incidence of AKI in hospitalized individuals varies depending on the definition used. AKI according to all definitions is associated with higher in-hospital mortality and resource utilization. AKI may be inappropriately diagnosed in those with low baseline serum creatinine using definitions that incorporate percentage increases over baseline.

Authors+Show Affiliations

Renal Division and , ‡General Internal Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;, †Department of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China, §Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24178971

Citation

Zeng, Xiaoxi, et al. "Incidence, Outcomes, and Comparisons Across Definitions of AKI in Hospitalized Individuals." Clinical Journal of the American Society of Nephrology : CJASN, vol. 9, no. 1, 2014, pp. 12-20.
Zeng X, McMahon GM, Brunelli SM, et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol. 2014;9(1):12-20.
Zeng, X., McMahon, G. M., Brunelli, S. M., Bates, D. W., & Waikar, S. S. (2014). Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clinical Journal of the American Society of Nephrology : CJASN, 9(1), pp. 12-20. doi:10.2215/CJN.02730313.
Zeng X, et al. Incidence, Outcomes, and Comparisons Across Definitions of AKI in Hospitalized Individuals. Clin J Am Soc Nephrol. 2014;9(1):12-20. PubMed PMID: 24178971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. AU - Zeng,Xiaoxi, AU - McMahon,Gearoid M, AU - Brunelli,Steven M, AU - Bates,David W, AU - Waikar,Sushrut S, Y1 - 2013/10/31/ PY - 2013/11/2/entrez PY - 2013/11/2/pubmed PY - 2014/9/10/medline SP - 12 EP - 20 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 9 IS - 1 N2 - BACKGROUND AND OBJECTIVES: At least four definitions of AKI have recently been proposed. This study sought to characterize the epidemiology of AKI according to the most recent consensus definition proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group, and to compare it with three other definitions. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective cohort study of 31,970 hospitalizations at an academic medical center in 2010. AKI was defined and staged according to KDIGO criteria, the Acute Dialysis Quality Initiative's RIFLE criteria, the Acute Kidney Injury Network (AKIN) criteria, and a definition based on a model of creatinine kinetics (CK). Outcomes of interest were incidence, in-hospital mortality, length of stay, costs, readmission rates, and posthospitalization disposition. RESULTS: AKI incidence was highest according to the KDIGO definition (18.3%) followed by the AKIN (16.6%), RIFLE (16.1%), and CK (7.0%) definitions. AKI incidence appeared markedly higher in those with low baseline serum creatinine according to the KDIGO, AKIN, and RIFLE definitions, in which AKI may be defined by a 50% increase over baseline. AKI according to all definitions was associated with a significantly higher risk of death and higher resource utilization. The adjusted odds ratios for in-hospital mortality in those with AKI were highest with the CK definition (5.2; 95% confidence interval [95% CI], 4.1 to 6.6), followed by the RIFLE (2.9; 95% CI, 2.2 to 3.6), KDIGO (2.8; 95% CI, 2.2 to 3.6), and AKIN (2.6; 95% CI, 2.0 to 3.3) definitions. Concordance in diagnosis and staging was high among the KDIGO, AKIN, and RIFLE definitions. CONCLUSIONS: The incidence of AKI in hospitalized individuals varies depending on the definition used. AKI according to all definitions is associated with higher in-hospital mortality and resource utilization. AKI may be inappropriately diagnosed in those with low baseline serum creatinine using definitions that incorporate percentage increases over baseline. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/24178971/Incidence_outcomes_and_comparisons_across_definitions_of_AKI_in_hospitalized_individuals_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=24178971 DB - PRIME DP - Unbound Medicine ER -