title: Survey of acute kidney injury and related risk factors of mortality in hospitalized patients in a third-level urban hospital of Shanghai.
abstract: OBJECTIVE
  The main aim of this study is to investigate the incidence and prognosis of acute kidney injury (AKI) and to clarify the risk factors associated with the prognosis of AKI in hospitalized patients.
  
  
  METHODS
  All patients hospitalized from January 1st to December 31st 2012 in Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University were screened by the Lab Administration Network. All the patients with an intact medical history of AKI according to the Acute Kidney Injury Network (AKIN) were enrolled in the study cohort. AKI's incidence and etiology, as well as the patient's characteristics and prognosis, were retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors on the patient prognosis and renal outcome.
  
  
  RESULTS
  934 AKI patients were enrolled. The incidence of AKI in hospitalized patients was 2.41%. The ratio of males to females of patients was 1.88:1 and the mean age was 60.82 ± 16.94. The incidence of AKI increased with increase in age. Among hospitalized patients, 63.4% were from the surgical department, 35.4% from the internal medicine department, and 1.2% from the obstetric and gynecologic department. Regarding the cause of AKI, pre-renal AKI, acute tubular necrosis (ATN), acute glomerulonephritis and vasculitis (AGV), acute interstitial nephritis (AIN), and post-renal AKI contributed with 51.7, 37.7, 3.8, 3.5, and 3.3%, respectively. The survival rate on the day 28 after AKI was 71.8%. In addition, 65.7% patients got complete renal recovery, while 16.9% got partial renal recovery and 17.4% got renal loss. The mortality of AKI in hospitalized patients at Stage I, Stage II and Stage III was 24.8, 31.2 and 43.7%, respectively. Multivariate Logistic regression analysis showed that use of nephrotoxic drugs, [Odds Ratio (OR) = 2.313], hypotension in the previous week (OR = 4.482), oliguria (OR = 5.267), the number of extra-renal organ failures (OR = 1.376), and need for renal replacement therapy (RRT) (OR = 4.221) were independent risk factors for mortality. The number of extra-renal organ failures (OR = 1.529) and RRT (OR = 2.117) were independent risk factors for renal loss.
  
  
  CONCLUSIONS
  AKI is one of the most common complications in hospitalized patients. The mortality is high and renal prognosis is poor after AKI. The prognosis is closely associated with the severity of AKI. Nephrotoxic drugs, hypotension within the last week, oliguria, the number of extra-renal organ failures, and RRT are independent risk factors for mortality, while the number of extra-renal organ failures and RRT are independent risk factors for renal loss.
authors.affiliation: Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China.
authors.forename: Renhua
authors.initials: R
authors.lastname: Lu
authors.forename: María-Jimena
authors.initials: MJ
authors.lastname: Muciño-Bermejo
authors.forename: Paolo
authors.initials: P
authors.lastname: Armignacco
authors.forename: Yan
authors.initials: Y
authors.lastname: Fang
authors.forename: Hong
authors.initials: H
authors.lastname: Cai
authors.forename: Minfang
authors.initials: M
authors.lastname: Zhang
authors.forename: Huili
authors.initials: H
authors.lastname: Dai
authors.forename: Weiming
authors.initials: W
authors.lastname: Zhang
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Ni
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Qian
authors.forename: Yucheng
authors.initials: Y
authors.lastname: Yan
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D002681:China; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006786:Hospitals, Urban; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D007683:Kidney Tubular Necrosis, Acute / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014657:Vasculitis / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology