Hospital-acquired and community-acquired acute renal failure in hospitalized Chinese: a ten-year review.
OBJECTIVE
To investigate the difference between hospital-acquired acute renal failure (HA-ARF) and community-acquired acute renal failure (CA-ARF) in hospitalized Chinese.


METHODS
The diagnosis of ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and subdivided into AC-ARF and HA-ARF. Data of epidemiology, etiology, prognosis, and associated factors were analyzed. Single-variable analysis and multivariate logistic regression analyses were performed to investigate the correlation between clinical features and prognosis respectively. Results among 205 reconfirmed CA-ARF had a predominance of 59.5%, but HA-ARF demonstrated an increase by 1.06 during the last five years (p = 0.003). In all, 70.5% CA-ARF was diagnosed in internal medicine with 45.9% in department of nephrology, whereas 59.1% HA-ARF was diagnosed in surgical department with 51.8% in ICU. Distribution difference among departments was significant (p < 0.01). Further, 90.2% CA-ARF was associated with a single factor, while 36.1% of HA-ARF had two or more causes (p < 0.01). Also, 26.5% HA-ARF and 18.9% CA-ARF was drug-associated (p > 0.05) while 24.1% HA-ARF and 12.3% CA-ARF was infection-associated (p < 0.01). HA-ARF vs. CA-ARF was 62.7% vs. 23.0% in mortality (p < 0.01), 0.54 +/- 0.24 vs. 0.27 +/- 0.18 in ATI-ISS index (p < 0.01) and 19.6 +/- 4.9 vs. 15.7 +/- 5.6 in APACHE II scores (p < 0.01). MODS and SIRS were common independent predictors with oliguria for HA-ARF and advanced age for CA-ARF, respectively.


CONCLUSIONS
In hospitalized Chinese during the last ten years, CA-ARF was still predominant with simpler cause and lower mortality, whereas HA-ARF was increasing with more complicated cause and higher mortality.
Wang
Yue
Y
Department of Nephrology, Peking University Third Hospital, Beijing, PR China. bjwangyue@sina.com.cn
Cui
Zhuan
Z
Fan
Minhua
M
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D002681:China / Q000453:epidemiology; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008875:Middle Aged; D009846:Oliguria / Q000209:etiology; D010045:Outpatients; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis