title: Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults.
abstract: OBJECTIVE
  Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China.
  
  
  METHODS
  This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and community-acquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed.
  
  
  RESULTS
  The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders.
  
  
  CONCLUSIONS
  AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization.
authors.affiliation: National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
authors.forename: Sheng
authors.initials: S
authors.lastname: Nie
authors.affiliation: The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China;
authors.forename: Zhangsuo
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Guangdong General Hospital, Guangzhou, China;
authors.forename: Chunbo
authors.initials: C
authors.lastname: Chen
authors.affiliation: Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China;
authors.forename: Gang
authors.initials: G
authors.lastname: Xu
authors.affiliation: Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China;
authors.forename: Yan
authors.initials: Y
authors.lastname: Zha
authors.affiliation: Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China;
authors.forename: Jing
authors.initials: J
authors.lastname: Qian
authors.affiliation: Zhongda Hospital, Southeast University, Nanjing, China;
authors.forename: Bicheng
authors.initials: B
authors.lastname: Liu
authors.affiliation: The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China; and.
authors.forename: Shuai
authors.initials: S
authors.lastname: Han
authors.affiliation: Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Anping
authors.initials: A
authors.lastname: Xu
authors.affiliation: National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
authors.forename: Xing
authors.initials: X
authors.lastname: Xu
authors.affiliation: National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; ffhouguangzhou@163.com.
authors.forename: Fan Fan
authors.initials: FF
authors.lastname: Hou
mesh_terms: D058186:Acute Kidney Injury / Q000191:economics / Q000453:epidemiology* / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D003422:Critical Care / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D004365:Drugs, Chinese Herbal / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D020127:Recovery of Function; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal; D003404:Creatinine
keywords: acute renal failure; epidemiology and outcomes; hospitalization