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Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults.
Clin J Am Soc Nephrol 2015; 10(9):1510-8CJ

Abstract

BACKGROUND AND OBJECTIVES

Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and community-acquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed.

RESULTS

The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders.

CONCLUSION

AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization.

Authors+Show Affiliations

National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China;Guangdong General Hospital, Guangzhou, China;Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China;Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China;Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China;Zhongda Hospital, Southeast University, Nanjing, China;The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China; and.Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; ffhouguangzhou@163.com.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26231194

Citation

Xu, Xin, et al. "Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults." Clinical Journal of the American Society of Nephrology : CJASN, vol. 10, no. 9, 2015, pp. 1510-8.
Xu X, Nie S, Liu Z, et al. Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults. Clin J Am Soc Nephrol. 2015;10(9):1510-8.
Xu, X., Nie, S., Liu, Z., Chen, C., Xu, G., Zha, Y., ... Hou, F. F. (2015). Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults. Clinical Journal of the American Society of Nephrology : CJASN, 10(9), pp. 1510-8. doi:10.2215/CJN.02140215.
Xu X, et al. Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults. Clin J Am Soc Nephrol. 2015 Sep 4;10(9):1510-8. PubMed PMID: 26231194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults. AU - Xu,Xin, AU - Nie,Sheng, AU - Liu,Zhangsuo, AU - Chen,Chunbo, AU - Xu,Gang, AU - Zha,Yan, AU - Qian,Jing, AU - Liu,Bicheng, AU - Han,Shuai, AU - Xu,Anping, AU - Xu,Xing, AU - Hou,Fan Fan, Y1 - 2015/07/31/ PY - 2015/02/24/received PY - 2015/06/16/accepted PY - 2015/8/2/entrez PY - 2015/8/2/pubmed PY - 2016/6/22/medline KW - acute renal failure KW - epidemiology and outcomes KW - hospitalization SP - 1510 EP - 8 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 10 IS - 9 N2 - BACKGROUND AND OBJECTIVES: Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and community-acquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed. RESULTS: The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders. CONCLUSION: AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/26231194/Epidemiology_and_Clinical_Correlates_of_AKI_in_Chinese_Hospitalized_Adults_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=26231194 DB - PRIME DP - Unbound Medicine ER -