title: Trends in the incidence of acute kidney injury in patients hospitalized with acute myocardial infarction.
abstract: BACKGROUND
  Acute kidney injury (AKI) is common in patients with acute myocardial infarction (AMI) and is associated with permanent renal impairment and death. Although guidelines increasingly emphasize AKI prevention, whether increased awareness has translated into reduced AKI rates is unclear.
  
  
  METHODS
  Among 33,249 consecutive hospitalizations in 31,532 unselected patients with AMI across 56 US centers from Cerner Corporation's Health Facts database, we examined the temporal trends in AKI incidence from 2000 to 2008. Acute kidney injury was defined as an absolute increase in creatinine level of at least 0.3 mg/dL or a relative increase of at least 50% during hospitalization.
  
  
  RESULTS
  From 2000 to 2008, the mean age of patients increased (from 66.5 to 68.6 years), as did the known AKI risk factors, including chronic kidney disease, cardiogenic shock, diabetes mellitus, heart failure, coronary angiography, and percutaneous coronary intervention. Despite this, AKI incidence declined from 26.6% in 2000 to 19.7% in 2008 (P < .001). After multivariate adjustment, the trend of decreasing AKI rates persisted (4.4% decline per year; P < .001). In addition, in-hospital mortality also declined over time among patients developing AKI, from 19.9% in 2000 to 13.8% in 2008 (P = .003).
  
  
  CONCLUSIONS
  In a large national study, AKI incidence in patients hospitalized with AMI declined significantly from 2000 to 2008 despite the aging population and rising prevalence of AKI risk factors. These findings may reflect increased clinician awareness, better risk stratification, or greater use of AKI prevention efforts during this time period.
authors.affiliation: Department of Cardiovascular Medicine, University of Missouri, Kansas City, MO 64111, USA.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Amin
authors.forename: Adam C
authors.initials: AC
authors.lastname: Salisbury
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Venkitachalam
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Stolker
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Phillip G
authors.initials: PG
authors.lastname: Jones
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology*; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*