[Epidemiology of acute kidney injury in Chinese critical patients].
OBJECTIVE
To investigate the epidemiological profile of acute kidney injury (AKI) in the Chinese critical patients.


METHODS
The hospitalization data and serum creatinine data of critically ill adult patients were collected from 9 regional central hospitals across China in 2013. Kidney Disease Improving Global Outcomes (KDIGO 2012) criteria was used to define and stage AKI. The demographic characteristics of the patients, comorbidities, stage of AKI, in-hospital outcomes and risk factors were retrospectively analyzed.


RESULTS
Of the total of 14 305 critically ill patients included in the study, 4298 (30.04%) were identified to have AKI, including 2240 (52.1%) in stage 1, 845 (19.7%) in stage 2, and 1213 (28.2%) in stage 3. The in-hospital mortality rate was 16.7% (716/4298) and the odds ratio for death was 7.59 (95%CI 6.54-8.79, P<0.001). The length of hospital stay, daily cost, and mortality rate were associated with the stage of AKI. Multivariate analysis identified chronic kidney disease (OR=5.45, 95%CI: 4.71-6.32, P<0.001), extra-renal organ failure (OR=12.57, 95%CI: 11.24-14.07, P<0.001), shock (OR=2.44, 95%CI: 2.01-2.96, P<0.001) and cardiac surgery (OR=5.96, 95%CI: 5.16-6.87, P<0.001) as the independent risk factors for AKI. Only 5.4% of the AKI patients whose serum creatinine change met the KDIGO criteria during hospitalization received the diagnosis of AKI upon discharge.


CONCLUSIONS
AKI is common in critically ill patients and associated with high mortality rates and poor outcomes. The stage of AKI is related with the in-hospital outcomes of the patients. Chronic kidney disease, extra-renal organ failure, shock and cardiac surgery are the major risk factors for AKI in these patients. Missed diagnosis occurs in most of the AKI cases, which urges more awareness of the condition in the critically ill patients during hospitalization.
Department of Nephrology, Nanfang Hospital, Southern Medical University/National Clinical Research Center for Kidney Disease/State Key Laboratory of Organ Failure Research, Guangzhou 510515, China. E-mail: leiying_1990922@163.com.
Ying
Y
Lei
Sheng
S
Nie
Dan-Hua
DH
Sun
Wei
W
Bin
Xin
X
Xu
D058186:Acute Kidney Injury / Q000453:epidemiology*; D000328:Adult; D006348:Cardiac Surgical Procedures; D002681:China; D016638:Critical Illness; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D007902:Length of Stay; D009102:Multiple Organ Failure / Q000453:epidemiology; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology