Hospital acquired and community-acquired acute kidney injury: A pilot study at a secondary referral hospital in queensland

Abstract

Aim: To examine the incidence of hospital-acquired acute kidney injury (HAAKI) and a newly defined community-acquired acute kidney injury (CAAKI) using a reverse KDIGO criteria Background: HAAKI and CAAKI are associated with increased mortality, length of hospital stay and substantial chronic kidney disease burden. Due to scarcity of pre-hospital phlebotomy CAAKI is difficult to diagnose. Methods: All adult patients who were admitted for more than a day with repeated measurements of renal function from 1st to 7th June 2014 were included in this study. The hospital bed management and pathology database were used for data collection. HAAKI was defined using standard KDIGO criteria: a rise in creatinine of 26.4 mmol/L over 48 hours or an increase in serum creatinine to ≥1.5 times within the last seven days. This study applied the reverse KDIGO criteria for CAAKI: an improvement in creatinine of 26.4 mmol/L over 48 hours or decrease in serum creatinine by ≤1.5 times by day 7. Results: 228 admissions (37.0%) fulfilled the study criteria and consisted of 161 medical (70.0%) and 68 (30.0%) surgical admissions. The mean age was 61 ± 19.2 years and 53.0% were male. The incidence of HAAKI was 3.6% (9 cases) and 66.7% of the cases were diagnosed at 48 hours and the remaining 33.3% were diagnosed at day 7. Meanwhile, the incidence of CAAKI was 4.9% (18 cases) with 16.7% diagnosed at 48 hours and 83.3% at 7 days. The predominant cause for HAAKI and CAAKI in this study population was pre-renal injury. Conclusions: The HAAKI and CAAKI rates in this single centre, secondary hospital were comparable to the published literature. Larger studies are required to validate the proposed reversed KDIGO criteria on CAAKI.<br />