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Title: Subacute kidney injury in hospitalized patients.
Austin Authors: Fujii, Tomoko;Uchino, Shigehiko;Takinami, Masanori;Bellomo, Rinaldo 
Affiliation: Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan, ‚ĆDepartment of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
Issue Date: 5-Dec-2013
Publication information: Clinical Journal of the American Society of Nephrology : Cjasn 2013; 9(3): 457-61
Abstract: 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.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.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).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.
Gov't Doc #: 24311710
DOI: 10.2215/CJN.04120413
Type: Journal Article
Subjects: Acute Kidney Injury.diagnosis.epidemiology.physiopathology
Hospital Mortality
Hospitals, Teaching
Kidney Diseases.diagnosis.epidemiology.mortality.physiopathology.therapy
Logistic Models
Middle Aged
Multivariate Analysis
Odds Ratio
Renal Replacement Therapy
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
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