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KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort

KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort
KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort
Background: Early recognition of acute kidney injury (AKI) is important. It frequently develops first in the community. KDIGO-based AKI e-alert criteria may help clinicians recognize AKI in hospitals, but their suitability for application in the community is unknown.

Methods: In a large renal cohort (n = 50 835) in one UK health authority, we applied the NHS England AKI ‘e-alert’ criteria to identify and follow three AKI groups: hospital-acquired AKI (HA-AKI), community-acquired AKI admitted to hospital within 7 days (CAA-AKI) and community-acquired AKI not admitted within 7 days (CANA-AKI). We assessed how AKI criteria operated in each group, based on prior blood tests (number and time lag). We compared 30-day, 1- and 5-year mortality, 90-day renal recovery and chronic renal replacement therapy (RRT).

Results: In total, 4550 patients met AKI e-alert criteria, 61.1% (2779/4550) with HA-AKI, 22.9% (1042/4550) with CAA-AKI and 16.0% (729/4550) with CANA-AKI. The median number of days since last blood test differed between groups (1, 52 and 69 days, respectively). Thirty-day mortality was similar for HA-AKI and CAA-AKI, but significantly lower for CANA-AKI (24.2, 20.2 and 2.6%, respectively). Five-year mortality was high in all groups, but followed a similar pattern (67.1, 64.7 and 46.2%). Differences in 5-year mortality among those not admitted could be explained by adjusting for comorbidities and restricting to 30-day survivors (hazard ratio 0.91, 95% confidence interval 0.80–1.04, versus hospital AKI). Those with CANA-AKI (versus CAA-AKI) had greater non-recovery at 90 days (11.8 versus 3.5%, P < 0.001) and chronic RRT at 5 years (3.7 versus 1.2%, P < 0.001).

Conclusions: KDIGO-based AKI criteria operate differently in hospitals and in the community. Some patients may not require immediate admission but are at substantial risk of a poor long-term outcome.
0931-0509
922-929
Sawhney, Simon
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Fluck, Nick
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Fraser, Simon D.
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Marks, Angharad
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Prescott, Gordon J.
8d0985a4-5168-4279-9d5f-bbecf4b8b9d7
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Black, Corri
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Sawhney, Simon
f1117f11-d5fd-4c2b-8bcc-6943d8f529d7
Fluck, Nick
fa42b929-5317-4308-8c38-fe9786e58191
Fraser, Simon D.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Marks, Angharad
5ba76546-8d85-4393-8d59-d3a177226cd8
Prescott, Gordon J.
8d0985a4-5168-4279-9d5f-bbecf4b8b9d7
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Black, Corri
2dd88049-95f0-484b-8aa0-878e8f52bf0e

Sawhney, Simon, Fluck, Nick, Fraser, Simon D., Marks, Angharad, Prescott, Gordon J., Roderick, Paul J. and Black, Corri (2016) KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort. Nephrology, Dialysis, Transplantation, 31 (6), 922-929. (doi:10.1093/ndt/gfw052). (PMID:27190340)

Record type: Article

Abstract

Background: Early recognition of acute kidney injury (AKI) is important. It frequently develops first in the community. KDIGO-based AKI e-alert criteria may help clinicians recognize AKI in hospitals, but their suitability for application in the community is unknown.

Methods: In a large renal cohort (n = 50 835) in one UK health authority, we applied the NHS England AKI ‘e-alert’ criteria to identify and follow three AKI groups: hospital-acquired AKI (HA-AKI), community-acquired AKI admitted to hospital within 7 days (CAA-AKI) and community-acquired AKI not admitted within 7 days (CANA-AKI). We assessed how AKI criteria operated in each group, based on prior blood tests (number and time lag). We compared 30-day, 1- and 5-year mortality, 90-day renal recovery and chronic renal replacement therapy (RRT).

Results: In total, 4550 patients met AKI e-alert criteria, 61.1% (2779/4550) with HA-AKI, 22.9% (1042/4550) with CAA-AKI and 16.0% (729/4550) with CANA-AKI. The median number of days since last blood test differed between groups (1, 52 and 69 days, respectively). Thirty-day mortality was similar for HA-AKI and CAA-AKI, but significantly lower for CANA-AKI (24.2, 20.2 and 2.6%, respectively). Five-year mortality was high in all groups, but followed a similar pattern (67.1, 64.7 and 46.2%). Differences in 5-year mortality among those not admitted could be explained by adjusting for comorbidities and restricting to 30-day survivors (hazard ratio 0.91, 95% confidence interval 0.80–1.04, versus hospital AKI). Those with CANA-AKI (versus CAA-AKI) had greater non-recovery at 90 days (11.8 versus 3.5%, P < 0.001) and chronic RRT at 5 years (3.7 versus 1.2%, P < 0.001).

Conclusions: KDIGO-based AKI criteria operate differently in hospitals and in the community. Some patients may not require immediate admission but are at substantial risk of a poor long-term outcome.

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Accepted/In Press date: 22 February 2016
e-pub ahead of print date: 7 April 2016
Published date: June 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 398767
URI: https://eprints.soton.ac.uk/id/eprint/398767
ISSN: 0931-0509
PURE UUID: df93916a-77c4-47a1-a687-170899bb6713
ORCID for Simon D. Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 02 Aug 2016 08:45
Last modified: 20 Jul 2019 01:19

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