title: Characteristics and outcomes in community-acquired versus hospital-acquired acute kidney injury.
abstract: OBJECTIVE
  Relatively little is known about the prevalence of acute kidney injury developing outside a hospital setting (CA-AKI) or the impact of CA-AKI on short-term or long-term clinical outcomes. The objective of this study was to compare the prevalence, causes, severity and outcomes of patients with CA-AKI and hospital-acquired (HA)-AKI.
  
  
  METHODS
  A retrospective cohort study of patients with AKI identified by ICD-9 code at a single VA (Veterans Affairs) hospital from September 1999 to May 2007 was performed. AKI was verified by applying the RIFLE criteria, and patients were categorized as CA-AKI if RIFLE criteria were met at admission. Demographic, clinical, and outcome variables were extracted by chart review.
  
  
  RESULTS
  Four hundred twenty-two patients met inclusion criteria, of which 335 (79.4%) developed CA-AKI. Patients with CA-AKI were more likely to have volume depletion as the aetiology, had fewer chronic illnesses and hospital complications, had a shorter length of stay, and had a reduced mortality, compared with HA-AKI. Distribution among the three RIFLE classes did not differ between groups, and recovery of renal function was incomplete in both groups.
  
  
  CONCLUSIONS
  We conclude that CA-AKI is a common cause of AKI that is as severe as that seen in HA-AKI. CA-AKI has a significant impact on length of hospital stay, mortality, and the development and/or progression of chronic kidney disease. Strategies to limit the risk of CA-AKI are likely to have a significant impact on healthcare costs and patient care.
authors: Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
authors: Michael M
authors: MM
authors: Schissler
authors: Syed
authors: S
authors: Zaidi
authors: Haresh
authors: H
authors: Kumar
authors: Datinder
authors: D
authors: Deo
authors: Michael E
authors: ME
authors: Brier
authors: Kenneth R
authors: KR
authors: McLeish
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D018450:Disease Progression; D017052:Hospital Mortality; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs