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Subacute kidney injury in hospitalized patients.
Clin J Am Soc Nephrol. 2014 Mar; 9(3):457-61.CJ

Abstract

BACKGROUND AND OBJECTIVES

The epidemiology of AKI and CKD has been described. However, the epidemiology of progressively worsening kidney function (subacute kidney injury [s-AKI]) developing over a longer time frame than defined for AKI (7 days), but shorter than defined for CKD (90 days), is completely unknown.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This retrospective study used a hospital laboratory and admission database. Adult patients admitted to a teaching hospital in Tokyo, Japan, between April 1, 2008, and October 31, 2011, were included. s-AKI was classified into three grades of severity (mild, moderate, severe) in accordance with the Risk, Injury, and Failure categories of the Risk, Injury, Failure, Risk, Loss, and ESRD classification, but did not use its time frame. Kidney injury (AKI and s-AKI) occurring during each hospital stay was identified, and logistic regression analysis was performed to assess their effect on hospital mortality.

RESULTS

Of 56,567 patients admitted to the hospital during the study period, 49,518 were included. Of these, 87.8% had no evidence of kidney dysfunction, 11.0% had AKI, and 1.1% had s-AKI. Patients with s-AKI had mild renal dysfunction in 82.7% of cases, moderate in 12.1%, and severe in 5.0%. Worsening s-AKI category was linearly correlated with hospital mortality, as previously described for AKI (no injury: 1.2%, mild: 6.5%, moderate: 12.9%, severe: 20.7%). Although mortality (8.0% versus 17.5%) and need for renal replacement therapy (0.2% versus 2.2%) were lower in patients with s-AKI than in those with AKI, multivariable regression analysis confirmed that s-AKI was an independent risk factor for hospital mortality (odds ratio (OR), 5.44; 95% confidence interval [95% CI], 3.89 to 7.44); the OR with AKI was 14.8 (95% CI, 13.2 to 16.7).

CONCLUSIONS

Close to 1% of hospitalized patients develop s-AKI. This condition is independently associated with increased hospital mortality, and the risk for death increases with s-AKI severity. Patients with s-AKI had a better outcome and were less likely to require renal replacement therapy than patients with AKI.

Authors+Show Affiliations

Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan, †Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

24311710

Citation

Fujii, Tomoko, et al. "Subacute Kidney Injury in Hospitalized Patients." Clinical Journal of the American Society of Nephrology : CJASN, vol. 9, no. 3, 2014, pp. 457-61.
Fujii T, Uchino S, Takinami M, et al. Subacute kidney injury in hospitalized patients. Clin J Am Soc Nephrol. 2014;9(3):457-61.
Fujii, T., Uchino, S., Takinami, M., & Bellomo, R. (2014). Subacute kidney injury in hospitalized patients. Clinical Journal of the American Society of Nephrology : CJASN, 9(3), 457-61. https://doi.org/10.2215/CJN.04120413
Fujii T, et al. Subacute Kidney Injury in Hospitalized Patients. Clin J Am Soc Nephrol. 2014;9(3):457-61. PubMed PMID: 24311710.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subacute kidney injury in hospitalized patients. AU - Fujii,Tomoko, AU - Uchino,Shigehiko, AU - Takinami,Masanori, AU - Bellomo,Rinaldo, Y1 - 2013/12/05/ PY - 2013/12/7/entrez PY - 2013/12/7/pubmed PY - 2014/11/11/medline SP - 457 EP - 61 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 9 IS - 3 N2 - BACKGROUND AND OBJECTIVES: The epidemiology of AKI and CKD has been described. However, the epidemiology of progressively worsening kidney function (subacute kidney injury [s-AKI]) developing over a longer time frame than defined for AKI (7 days), but shorter than defined for CKD (90 days), is completely unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective study used a hospital laboratory and admission database. Adult patients admitted to a teaching hospital in Tokyo, Japan, between April 1, 2008, and October 31, 2011, were included. s-AKI was classified into three grades of severity (mild, moderate, severe) in accordance with the Risk, Injury, and Failure categories of the Risk, Injury, Failure, Risk, Loss, and ESRD classification, but did not use its time frame. Kidney injury (AKI and s-AKI) occurring during each hospital stay was identified, and logistic regression analysis was performed to assess their effect on hospital mortality. RESULTS: Of 56,567 patients admitted to the hospital during the study period, 49,518 were included. Of these, 87.8% had no evidence of kidney dysfunction, 11.0% had AKI, and 1.1% had s-AKI. Patients with s-AKI had mild renal dysfunction in 82.7% of cases, moderate in 12.1%, and severe in 5.0%. Worsening s-AKI category was linearly correlated with hospital mortality, as previously described for AKI (no injury: 1.2%, mild: 6.5%, moderate: 12.9%, severe: 20.7%). Although mortality (8.0% versus 17.5%) and need for renal replacement therapy (0.2% versus 2.2%) were lower in patients with s-AKI than in those with AKI, multivariable regression analysis confirmed that s-AKI was an independent risk factor for hospital mortality (odds ratio (OR), 5.44; 95% confidence interval [95% CI], 3.89 to 7.44); the OR with AKI was 14.8 (95% CI, 13.2 to 16.7). CONCLUSIONS: Close to 1% of hospitalized patients develop s-AKI. This condition is independently associated with increased hospital mortality, and the risk for death increases with s-AKI severity. Patients with s-AKI had a better outcome and were less likely to require renal replacement therapy than patients with AKI. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/24311710/Subacute_kidney_injury_in_hospitalized_patients_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=24311710 DB - PRIME DP - Unbound Medicine ER -