Incidence, care quality and outcomes of patients with acute kidney injury in admitted hospital care.
BACKGROUND
Acute kidney injury (AKI) is common in acute hospital admission and associated with worse patient outcomes.


OBJECTIVE
To measure incidence, care quality and outcome of AKI in admitted hospital care.


METHODS
Forty-six of 168 acute NHS healthcare trusts in UK caring for 2 million acute hospital admissions per annum collected information on adults identified with AKI stage 3 (3-fold rise in serum creatinine or creatinine >354 µmol/l) through routine biochemical testing over a 5-month period in 2012.


METHODS
Information was collected on patient and care characteristics. Primary outcomes were survival and recovery of kidney function at 1 month.


RESULTS
A total of 15 647 patients were identified with biochemical AKI stage 3. Case note reviews were available for 7726 patients. In 80%, biochemical AKI stage 3 was confirmed clinically. Among this group, median age was 75 years, median length of stay was 12 days and the overall mortality within 1 month was 38%. Significant factors in a multivariable model predicting survival included age and some causes of AKI. Dipstick urinalysis, medication review, discussion with a nephrologist and acceptance for transfer to a renal unit were also associated with higher survival, but not early review by a senior doctor, acceptance for transfer to critical care or requirement for renal replacement therapy. Eighteen percent of people did not have their kidney function checked 1 month after the episode had resolved.


CONCLUSIONS
This large study of in-hospital AKI supports the efficacy of biochemical detection of AKI in common usage. AKI mortality remains substantial, length of stay comparable with single-centre studies, and much of the variation is poorly explained (model Cox and Snell R2=0.131) from current predictors.
From the John Walls Renal Unit, Leicester, UK james.medcalf@nhs.net.
J F
JF
Medcalf
Public Health Analyst, Knowledge Intelligence Service Public Health England, Nottingham, UK.
C
C
Davies
Public Health Analyst, Knowledge Intelligence Service Public Health England, Nottingham, UK.
J
J
Hollinshead
Long Term Conditions Programme Lead, Sustainable Improvement Team, NHS England, Leeds, UK.
B
B
Matthews
Salford Royal NHS Foundation Trust, Salford, UK.
D
D
O'Donoghue
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs; D011787:Quality of Health Care; D017582:Renal Replacement Therapy; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
D015415:Biomarkers; D003404:Creatinine