Propensity-score-matched evaluation of under-recognition of acute kidney injury and short-term outcomes

Buyun Wu, Li Li, Xiaoyan Cheng, Wenyan Yan, Yun Liu, Changying Xing, Huijuan Mao, Buyun Wu, Li Li, Xiaoyan Cheng, Wenyan Yan, Yun Liu, Changying Xing, Huijuan Mao

Abstract

Acute kidney injury (AKI) is a common disease, but diagnosis is usually delayed or missed in hospitalized patients. The aim of this study was to investigate the impact of under-recognition of AKI (beyond 3 days after AKI onset) on short-time prognosis. Of 785 patients with under-recognition of AKI and 616 patients with timely-recognition of AKI were propensity matched in a 1:1 ratio. The two groups, with a total of 482 matched patients (241:241), were comparable in baseline covariates. Under-recognition of AKI was not associated with 30-day all-cause mortality in the logistic regression model with covariate adjustment (OR = 1.01, 95% CI = 0.62-1.64, p = 0.967). Sensitivity analyses and subgroup analyses also proved the association. There were also no significant differences in causes of 30-day mortality, in-hospital mortality, recovery of renal function at discharge, length of hospital stay, length of intensive care unit stay or hospitalization costs between the two groups, although timely-recognition group had more chance of renal consult and a little more interventions for AKI. In conclusion, under-recognition of AKI may not be associated with poor short-term outcomes of adult hospitalized patients via these propensity-score-matched analyses.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of patient selection.
Figure 2
Figure 2
Kaplan–Meier plots of 30-day all-cause mortality after onset of acute kidney injury (AKI).
Figure 3
Figure 3
Subgroup analyses of whether under-recognition of AKI increased risk of 30-day all-cause mortality. Abbreviations: AKI, acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation II; ICU: intensive care unit.

References

    1. Mehta RL, et al. International Society of Nephrology’s 0 by 25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015;385:2616–2643. doi: 10.1016/S0140-6736(15)60126-X.
    1. An JN, et al. Chronic Kidney Disease After Acute Kidney Injury Requiring Continuous Renal Replacement Therapy and Its Impact on Long-Term Outcomes: A Multicenter Retrospective Cohort Study in Korea. Critical care medicine. 2017;45:47–57. doi: 10.1097/CCM.0000000000002012.
    1. Doyle JF, Forni LG. Acute kidney injury: short-term and long-term effects. Critical care. 2016;20:188. doi: 10.1186/s13054-016-1353-y.
    1. Shiao CC, et al. Long-term remote organ consequences following acute kidney injury. Critical care. 2015;19:438. doi: 10.1186/s13054-015-1149-5.
    1. Soliman IW, et al. The predictive value of early acute kidney injury for long-term survival and quality of life of critically ill patients. Critical care. 2016;20:242. doi: 10.1186/s13054-016-1416-0.
    1. Varrier M, Forni LG, Ostermann M. Long-term sequelae from acute kidney injury: potential mechanisms for the observed poor renal outcomes. Critical care. 2015;19:102. doi: 10.1186/s13054-015-0805-0.
    1. Wilson FP, et al. The impact of documentation of severe acute kidney injury on mortality. Clinical nephrology. 2013;80:417–425. doi: 10.5414/CN108072.
    1. Yang L, et al. Acute kidney injury in China: a cross-sectional survey. Lancet. 2015;386:1465–1471. doi: 10.1016/S0140-6736(15)00344-X.
    1. Lewington AJ, Cerda J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney international. 2013;84:457–467. doi: 10.1038/ki.2013.153.
    1. Rosenbaum P. The consquences of adjustment for a concomitant variable that has been affected by the treatment. J Roy Stat Soc Ser. 1984;A147:656–666. doi: 10.2307/2981697.
    1. Uchino E, Kondo N, Matsubara T, Yanagita M. Automated Electronic Alert Systems for Acute Kidney Injury: Current Status and Future Perspectives. Contributions to nephrology. 2017;189:124–129. doi: 10.1159/000452260.
    1. Cheng X, Wu B, Liu Y, Mao H, Xing C. Incidence and diagnosis of Acute kidney injury in hospitalized adult patients: a retrospective observational study in a tertiary teaching Hospital in Southeast China. BMC nephrology. 2017;18:203. doi: 10.1186/s12882-017-0622-6.
    1. Sundararajan V, et al. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. Journal of clinical epidemiology. 2004;57:1288–1294. doi: 10.1016/j.jclinepi.2004.03.012.
    1. Waters M, Nightingale P, Edwards JD. Apache II scores. Anaesthesia. 1988;43:896–898. doi: 10.1111/j.1365-2044.1988.tb05623.x.
    1. Vincent JL, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive care medicine. 1996;22:707–710. doi: 10.1007/BF01709751.
    1. Gaiao S, Cruz DN. Baseline creatinine to define acute kidney injury: is there any consensus? Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2010;25:3812–3814. doi: 10.1093/ndt/gfq454.
    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl3, 1–150 (2013).
    1. VA/NIH Acute Renal Failure Trial Network. et al. Intensity of renal support in critically ill patients with acute kidney injury. The New England journal of medicine359, 7–20, 10.1056/NEJMoa0802639 (2008).
    1. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Critical care medicine20, 864–874 (1992).
    1. Fraeman, K. An introduction to implementing propensity score matching with SAS. (2010).
    1. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Statistics in medicine. 2009;28:3083–3107. doi: 10.1002/sim.3697.
    1. Schacht A, Bogaerts K, Bluhmki E, Lesaffre E. A new nonparametric approach for baseline covariate adjustment for two-group comparative studies. Biometrics. 2008;64:1110–1116. doi: 10.1111/j.1541-0420.2008.00994.x.
    1. Elze MC, et al. Comparison of Propensity Score Methods and Covariate Adjustment: Evaluation in 4 Cardiovascular Studies. Journal of the American College of Cardiology. 2017;69:345–357. doi: 10.1016/j.jacc.2016.10.060.
    1. Susantitaphong P, et al. World incidence of AKI: a meta-analysis. Clinical journal of the American Society of Nephrology: CJASN. 2013;8:1482–1493. doi: 10.2215/CJN.00710113.
    1. Wilson FP, et al. Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. Lancet. 2015;385:1966–1974. doi: 10.1016/S0140-6736(15)60266-5.
    1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International Supplements2, 1–138, 10.1038/kisup.2012.1 (2012).
    1. Wu, Y. et al. Attitudes and practices of Chinese physicians regarding chronic kidney disease and acute kidney injury management: a questionnaire-based cross-sectional survey in secondary and tertiary hospitals. International urology and nephrology, 10.1007/s11255-018-1882-1 (2018).

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