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Community-Acquired Acute Kidney Injury: A Nationwide Survey in China.
Am J Kidney Dis 2017; 69(5):647-657AJ

Abstract

BACKGROUND

This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI.

STUDY DESIGN

Cross-sectional and retrospective study.

SETTING & PARTICIPANTS

A national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission.

PREDICTORS

The rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted.

OUTCOMES

All-cause in-hospital mortality and recovery of kidney function at hospital discharge.

RESULTS

4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor.

LIMITATIONS

Possible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine.

CONCLUSIONS

The features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources.

Authors+Show Affiliations

Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China. Electronic address: li.yang@bjmu.edu.cn.Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28117208

Citation

Wang, Yafang, et al. "Community-Acquired Acute Kidney Injury: a Nationwide Survey in China." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 69, no. 5, 2017, pp. 647-657.
Wang Y, Wang J, Su T, et al. Community-Acquired Acute Kidney Injury: A Nationwide Survey in China. Am J Kidney Dis. 2017;69(5):647-657.
Wang, Y., Wang, J., Su, T., Qu, Z., Zhao, M., & Yang, L. (2017). Community-Acquired Acute Kidney Injury: A Nationwide Survey in China. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 69(5), pp. 647-657. doi:10.1053/j.ajkd.2016.10.034.
Wang Y, et al. Community-Acquired Acute Kidney Injury: a Nationwide Survey in China. Am J Kidney Dis. 2017;69(5):647-657. PubMed PMID: 28117208.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Community-Acquired Acute Kidney Injury: A Nationwide Survey in China. AU - Wang,Yafang, AU - Wang,Jinwei, AU - Su,Tao, AU - Qu,Zhen, AU - Zhao,Minghui, AU - Yang,Li, AU - ,, Y1 - 2017/01/20/ PY - 2016/05/10/received PY - 2016/10/29/accepted PY - 2017/1/25/pubmed PY - 2017/8/2/medline PY - 2017/1/25/entrez KW - Acute kidney injury (AKI) KW - China KW - community-acquired AKI KW - decreased kidney perfusion KW - etiology KW - health disparities KW - incidence KW - mortality KW - nationwide survey KW - per capita gross domestic product KW - regional variation KW - renal replacement therapy (RRT) KW - serum creatinine SP - 647 EP - 657 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 69 IS - 5 N2 - BACKGROUND: This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI. STUDY DESIGN: Cross-sectional and retrospective study. SETTING & PARTICIPANTS: A national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission. PREDICTORS: The rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted. OUTCOMES: All-cause in-hospital mortality and recovery of kidney function at hospital discharge. RESULTS: 4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor. LIMITATIONS: Possible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine. CONCLUSIONS: The features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/28117208/Community_Acquired_Acute_Kidney_Injury:_A_Nationwide_Survey_in_China_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)30671-0 DB - PRIME DP - Unbound Medicine ER -