title: Acute kidney injury risk assessment at the hospital front door: what is the best measure of risk?
abstract: BACKGROUND
  We examined the prevalence of acute kidney injury (AKI) risk factors in the emergency medical unit, generated a modified risk assessment tool and tested its ability to predict AKI.
  
  
  METHODS
  A total of 1196 patients admitted to medical admission units were assessed for patient-associated AKI risk factors. Subsequently, 898 patients were assessed for a limited number of fixed risk factors with the addition of hypotension and sepsis. This was correlated to AKI episodes.
  
  
  RESULTS
  In the first cohort, the prevalence of AKI risk factors was 2.1 ± 2.0 per patient, with a positive relationship between age and the number of risk factors and a higher number of risk factors in patients ≥65 years. In the second cohort, 12.3% presented with or developed AKI. Patients with AKI were older and had a higher number of AKI risk factors. In the AKI cohort, 72% of the patients had two or more AKI risk factors compared with 43% of the cohort with no AKI. When age ≥65 years was added as an independent risk factor, 84% of those with AKI had two or more AKI risk factors compared with 55% of those with no AKI. Receiver operating characteristic analysis suggests that the use of common patient-associated known AKI risk factors performs no better than age alone as a predictor of AKI.
  
  
  CONCLUSIONS
  Detailed assessment of well-established patient-associated AKI risk factors may not facilitate clinicians to apportion risk. This suggests that additional work is required to develop a more sensitive validated AKI-predictive tool that would be useful in this clinical setting.
authors.affiliation: Department of Medicine , Aneurin Bevan University Health Board , Royal Gwent Hospital , Newport , UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Roberts
authors.affiliation: Insititute of Nephrology , Cardiff University School of Medicine , Cardiff , UK.
authors.forename: Dafydd
authors.initials: D
authors.lastname: Phillips
authors.affiliation: Department of Medicine , Cardiff and Vale University Health Board , University Hospital of Wales , Cardiff , UK.
authors.forename: Rowan
authors.initials: R
authors.lastname: McCarthy
authors.affiliation: Department of Medicine , Cardiff and Vale University Health Board , University Hospital of Wales , Cardiff , UK.
authors.forename: Hemanth
authors.initials: H
authors.lastname: Bolusani
authors.affiliation: Department of Medicine , Aneurin Bevan University Health Board , Royal Gwent Hospital , Newport , UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Mizen
authors.affiliation: Department of Medicine , Cwm Taf University Health Board Prince Charles Hospital , Merthyr Tydfil , UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hassan
authors.affiliation: Department of Medicine , Cwm Taf University Health Board Prince Charles Hospital , Merthyr Tydfil , UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hooper
authors.affiliation: Department of Medicine , Cwm Taf University Health Board Prince Charles Hospital , Merthyr Tydfil , UK.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Saddler
authors.affiliation: Department of Medicine , Cardiff and Vale University Health Board, University Hospital Llandough , Cardiff , UK.
authors.forename: Mo
authors.initials: M
authors.lastname: Hu
authors.affiliation: Department of Medicine , Cardiff and Vale University Health Board, University Hospital Llandough , Cardiff , UK.
authors.forename: Sonal
authors.initials: S
authors.lastname: Lodhi
authors.affiliation: Department of Medicine , Cardiff and Vale University Health Board, University Hospital Llandough , Cardiff , UK.
authors.forename: Ella
authors.initials: E
authors.lastname: Toynton
authors.affiliation: Department of Clinical Biochemistry, Cwm Taf University Health Board and Faculty of Life Sciences and Education , University of South Wales , Cardiff , UK.
authors.forename: John
authors.initials: J
authors.lastname: Geen
authors.affiliation: Department of Medicine , Cardiff and Vale University Health Board, University Hospital Llandough , Cardiff , UK.
authors.forename: Vikas
authors.initials: V
authors.lastname: Lodhi
authors.affiliation: Department of Medicine , Aneurin Bevan University Health Board , Royal Gwent Hospital , Newport , UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Grose
authors.affiliation: Insititute of Nephrology , Cardiff University School of Medicine , Cardiff , UK.
authors.forename: Aled
authors.initials: A
authors.lastname: Phillips
keywords: AKI; acute tubular necrosis; chronic renal failure; chronic renal insufficiency; epidemiology