title: Prehospitalization Risk Factors for Acute Kidney Injury during Hospitalization for Serious Infections in the REGARDS Cohort.
abstract: OBJECTIVE
  Acute kidney injury (AKI) frequently occurs in hospitalized patients. In this study, we determined prehospitalization characteristics associated with AKI in community-dwelling adults hospitalized for a serious infection.
  
  
  METHODS
  We used prospective data from 30,239 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national cohort of community-dwelling adults ≥45 years old. We identified serious infection hospitalizations between 2003 and 2012. Using the Kidney Disease Improving Global Outcomes (KDIGO) criteria, we defined AKI as an increase in serum creatinine (sCr) ≥0.3 mg/dl from the first inpatient sCr measurement during the first 7 hospitalization days. We excluded individuals with a history of renal transplant or preexisting end-stage renal disease as well as individuals with <2 sCr measurements. We identified baseline characteristics (sociodemographics, health behaviors, chronic medical conditions, biomarkers, and nonsteroidal anti-inflammatory, statin, or antihypertensive medication use) independently associated with AKI events using multivariable generalized estimating equations.
  
  
  RESULTS
  Over a median follow-up of 4.5 years (interquartile range 2.4-6.3), we included 2,074 serious infection hospitalizations among 1,543 individuals. AKI occurred in 296 of 2,074 hospitalizations (16.5%). On multivariable analysis, prehospitalization characteristics independently associated with AKI among individuals hospitalized for a serious infection included a history of diabetes [odds ratio (OR) 1.38; 95% CI 1.02-1.89], increased cystatin C (OR 1.73 per SD; 95% CI 1.20-2.50), and increased albumin-to-creatinine ratio (OR 1.19 per SD; 95% CI 1.007-1.40). Sex, race, hypertension, myocardial infarction, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and the use of nonsteroidal anti-inflammatory, statin, or antihypertensive medications were not associated with AKI.
  
  
  CONCLUSIONS
  Community-dwelling adults with a history of diabetes or increased cystatin C or albumin-to-creatinine ratio are at increased risk for AKI after hospitalization for a serious infection. These findings may be used to identify individuals at high risk for AKI.
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, Ala., USA.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, Ala., USA.
authors.forename: T Clark
authors.initials: TC
authors.lastname: Powell
authors.affiliation: Division of Nephrology, University of Alabama School of Medicine, Ala., USA ; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Ala., USA.
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Ala., USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Griffin
authors.affiliation: Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Ala., USA.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
keywords: Acute kidney injury; Epidemiology; Infections; Risk prediction