title: Differences in community, hospital and intensive care unit-acquired acute kidney injury: observational study in a nephrology service of a developing country.
abstract: BACKGROUND
  Acute kidney injury (AKI) complicates more than 7% of all in-hospital patients. The aim of this study is to investigate the differences in community, hospital and intensive care unit-acquired AKI in patients undergoing nephrology consultation in a tertiary hospital in a developing country.
  
  
  METHODS
  An observational cohort study of all patients with AKI admitted to the General Hospital of Fortaleza, Brazil was conducted. RIFLE criteria were used to classify the patients and to assess their association with death. Univariate and multivariate analyses were performed to investigate the factors associated with death.
  
  
  RESULTS
  Of 491 AKI patients undergoing nephrology consultation, the mean age was 55.2 ± 22.9 years. Community-acquired AKI was observed in 55% of cases, general ward-acquired in 29% and ICU-acquired in 15.3%. Late Nephrology consultation was observed, and the great majority of patients had "Failure" classification (90%) according to RIFLE criteria. Intermittent hemodialysis was required in 68% of cases. The overall in-hospital mortality was 23%. The in-hospital mortality was higher in ICU-acquired AKI (33.6%). Community acquired AKI had a higher mortality than general ward-acquired AKI (23% vs. 11.6%, p = 0.001). Risk factors for death were infection (OR = 2.0, p = 0.003), neoplasms (OR = 1.89, p = 0.042), community acquired-AKI (OR = 1.27, p = 0.003), ICU acquired-AKI (OR = 2.76, p < 0.0001) and need for renal replacement therapy (OR = 2.64, p < 0.001).
  
  
  CONCLUSIONS
  AKI is a frequent and frequently fatal condition. Mortality was higher in community and ICU-acquired than hospital ward-acquired AKI.
authors.affiliation: Division of Mephrology, General Hospital of Fortaleza, Brazil.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Daher
authors.forename: Geraldo B
authors.initials: GB
authors.lastname: Silva Junior
authors.forename: Silvia Q
authors.initials: SQ
authors.lastname: Santos
authors.forename: Carla Camila
authors.initials: CC
authors.lastname: R Bezerra
authors.forename: Elton J B
authors.initials: EJ
authors.lastname: Diniz
authors.forename: Rafael S A
authors.initials: RS
authors.lastname: Lima
authors.forename: Célio A
authors.initials: CA
authors.lastname: Babosa
authors.forename: Antonio Augusto
authors.initials: AA
authors.lastname: C Guimarães
authors.forename: Rosa M S
authors.initials: RM
authors.lastname: Mota
authors.forename: Krasnalhia Lívia S
authors.initials: KL
authors.lastname: Abreu
authors.forename: Alexandre B
authors.initials: AB
authors.lastname: Libório
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009398:Nephrology