Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury: A Retrospective Cohort Study

Chien-Ning Hsu, Chien-Te Lee, Chien-Hao Su, Yu-Ching Lily Wang, Hsiao-Ling Chen, Jiin-Haur Chuang, You-Lin Tain, Chien-Ning Hsu, Chien-Te Lee, Chien-Hao Su, Yu-Ching Lily Wang, Hsiao-Ling Chen, Jiin-Haur Chuang, You-Lin Tain

Abstract

The disease burden and outcomes of community-acquired (CA-) and hospital-acquired acute kidney injury (HA-AKI) are not well understood. The aim of the study was to investigate the incidence, outcomes, and risk factors of AKI in a large Taiwanese adult cohort.This retrospective cohort study examined 734,340 hospital admissions from a group of hospitals within an organization in Taiwan between January 1, 2010 and December 31, 2014. Patients with AKI at discharge were classified as either CA- or HA-AKI based on the RIFLE (risk, injury, failure, loss of function, end stage of kidney disease) classification criteria. Outcomes were in-hospital mortality, dialysis, recovery of renal function, and length of stay. Risks of developing AKI were determined using multivariate logistic regression based on demographic and baseline clinical characteristics and nephrotoxin use before admission.AKI occurred in 1.68% to 2% hospital discharges among adults without and with preexisting chronic kidney disease (CKD), respectively. The incidence of CA-AKI was 17.25 and HA-AKI was 8.14 per 1000 admissions. The annual rate of CA-AKI increased from 12.43 to 19.96 per 1000 people, but the change in HA-AKI was insignificant. Comparing to CA-AKI, those with HA-AKI had higher levels of in-hospital mortality (26.07% vs 51.58%), mean length of stay (21.25 ± 22.35 vs 35.84 ± 34.62 days), and dialysis during hospitalization (1.45% vs 2.06%). Preexisting systemic diseases, including CKD were associated with increased risks of CA-AKI, and nephrotoxic polypharmacy increased risk of both CA- and HA-AKI.Patients with HA-AKI had more severe outcomes than patients with CA-AKI, and demonstrated different spectrum of risk factors. Although patients with CA-AKI with better outcomes, the incidence increased over time. It is also clear that optimal preventive and management strategies of HA- and CA-AKI are urgently needed to limit the risks in susceptible individuals.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Incidence of discharges with a diagnosis of AKI and mortality rate, 2010–2014; AKI = acute kidney injury.
FIGURE 2
FIGURE 2
Incidence rate of RIFLE-based AKI, by calendar year and severity. Data are presented as mean cases per 1000 hospitalized adults. AKI = acute kidney injury, CA-AKI = community-acquired AKI, HA-AKI = hospital-acquired AKI, RIFLE = risk, injury, failure, loss of function, and end stage of renal disease.
FIGURE 3
FIGURE 3
Risk factors associated with RIFLE-AKI. (A) CA-AKI vs non-RIFLE AKI. (B) HA-AKI vs non-RIFLE AKI. AKI = acute kidney injury, CA-AKI = community-acquired AKI, CHF = congestive heart failure, CI = confidence interval, CKD = chronic kidney disease, CVD = cerebrovascular disease, DM = diabetes mellitus, HA-AKI = hospital-acquired AKI, non-RIFLE AKI = patients with a discharge diagnosis of AKI but not meeting the RIFLE criteria (i.e., SCr changes 

FIGURE 4

Prior uses of nephrotoxic medicines…

FIGURE 4

Prior uses of nephrotoxic medicines in patients with RIFLE AKI. (A) Number of…

FIGURE 4
Prior uses of nephrotoxic medicines in patients with RIFLE AKI. (A) Number of nephrotoxic medicines, by CA- and HA-AKI; Cochran–Armitage test suggests that the probability of CA-AKI increases with nephrotoxic polypharmacy (Z = 10.94, 1-sided P < 0.0001). (B) Number of nephrotoxic medicines by severity of RIFLE stages; Cochran–Armitage test for failure (vs risk stage), Z =  − 6.52, 1-sided P < 0.0001; Cochran–Armitage test for injury (vs risk stage), Z = 0.70, 1-sided P = 0.24. CA-AKI = community-acquired acute kidney injury, HA-AKI = hospital-acquired AKI, non-RIFLE AKI = patients discharged with a diagnosis of AKI but not meeting the RIFLE criteria (i.e., SCr changes < 1.5 times), RIFLE = risk injury failure loss of function and end stage of renal disease.
FIGURE 4
FIGURE 4
Prior uses of nephrotoxic medicines in patients with RIFLE AKI. (A) Number of nephrotoxic medicines, by CA- and HA-AKI; Cochran–Armitage test suggests that the probability of CA-AKI increases with nephrotoxic polypharmacy (Z = 10.94, 1-sided P < 0.0001). (B) Number of nephrotoxic medicines by severity of RIFLE stages; Cochran–Armitage test for failure (vs risk stage), Z =  − 6.52, 1-sided P < 0.0001; Cochran–Armitage test for injury (vs risk stage), Z = 0.70, 1-sided P = 0.24. CA-AKI = community-acquired acute kidney injury, HA-AKI = hospital-acquired AKI, non-RIFLE AKI = patients discharged with a diagnosis of AKI but not meeting the RIFLE criteria (i.e., SCr changes < 1.5 times), RIFLE = risk injury failure loss of function and end stage of renal disease.

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