Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology.
BACKGROUND
Epidemiological studies of acute kidney injury (AKI) have focused on patients admitted to intensive care units (ICUs), and several have studied hospitalized non-ICU patients, but analysis of patients referred to Nephrology is sparse. We analyzed factors associated with short- and long-term morbimortality among hospitalized non-ICU patients with AKI who were referred to Nephrology.


METHODS
A retrospective study with data prospectively collected from 170 non-ICU patients, with referral to the Nephrology Unit, recruited over a 4-year period, was performed. AKI was classified according to the criteria based on risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE). Risk factors that could influence prognosis of AKI and long-term mortality were analyzed at admission. Early on, 1- and 10-year mortalities were correlated with AKI RIFLE class, clinical and demographic characteristics.


RESULTS
Most patients were >65 years, with multiple comorbidities and frequent drug intake history. Median Charlson score was 6. Twenty-five percent of patients with previously unknown chronic kidney disease (CKD) were diagnosed with CKD during the study. Dialysis was required in 13.5% of patients. Hospital deaths were 22.4% and significantly associated with older age, RIFLE class L, higher peak serum creatinine, oliguria and decreased serum albumin levels. One-year (38.8%) and 10-year (68.8%) mortalities were significantly associated with age, prior cardiovascular disease, prior CKD and RIFLE class L. According to the Cox proportional hazard model, age, prior CKD and RIFLE class L were independent risk factors of death at 1 and 10 years.


CONCLUSIONS
AKI in hospitalized non-ICU patients is associated with high early and late mortality. This study increases our understanding of AKI among this specific population and can improve their management.
Nephrology Department, University Hospital Marqux00E9;s de Valdecilla, Santander, Spain.
Jorge
J
Ruiz-Criado
Maria-Angeles
MA
Ramos-Barron
Gema
G
Fernandez-Fresnedo
Emilio
E
Rodrigo
Angel-Luis Martin
AL
De Francisco
Manuel
M
Arias
Carlos
C
Gomez-Alamillo
D058186:Acute Kidney Injury / Q000401:mortality*; D000368:Aged; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D009398:Nephrology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000401:mortality / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D016019:Survival Analysis
D012709:Serum Albumin; D003404:Creatinine