title: Referral patterns and outcomes in noncritically ill patients with hospital-acquired acute kidney injury.
abstract: OBJECTIVE
  Despite modern treatment, the case fatality rate of hospital-acquired acute kidney injury (HA-AKI) is still high. We retrospectively described the prevalence and the outcome of HA-AKI without nephrology referral (nrHA-AKI) and late referred HA-AKI patients to nephrologists (lrHA-AKI) compared with early referral patients (erHA-AKI) with respect to renal function recovery, renal replacement therapy (RRT) requirement, and in-hospital mortality of HA-AKI.
  
  
  METHODS
  Noncritically ill patients admitted to the tertiary care academic center of Lausanne, Switzerland, between 2004 and 2008 in the medical and surgical services were included. Acute kidney injury was defined using the Acute Kidney Injury Network (AKIN) classification.
  
  
  RESULTS
  During 5 years, 4296 patients (4.12% of admissions) experienced 4727 episodes of HA-AKI during their hospital stay. The mean ± SD age of the patients was 61 ± 15 years with a 55% male predominance. There were 958 patients with nrHA-AKI (22.3%) and 2504 patients with lrHA-AKI (58.3%). RRT was required in 31% of the patients with lrHA-AKI compared with 24% of the patients with erHA-AKI. In the multiple risk factor analysis, compared with erHA-AKI, nrHA-AKI and lrHA-AKI were significantly associated with worse renal outcome and higher in-hospital mortality.
  
  
  CONCLUSIONS
  These data suggest that HA-AKI is frequent and the patients with nrHA-AKI or lrHA-AKI are at increased risk for in-hospital morbidity and mortality.
authors.affiliation: Service of Nephrology, Centre Hospitalier Universitaire Vaudoisand University of Lausanne, Lausanne, Switzerland. pascal.meier@chuv.ch
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
authors.forename: Rachel Meier
authors.initials: RM
authors.lastname: Bonfils
authors.forename: Bruno
authors.initials: B
authors.lastname: Vogt
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: Michel
authors.initials: M
authors.lastname: Burnier
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D017582:Renal Replacement Therapy; D012189:Retrospective Studies
chemical_list: D003404:Creatinine