A nationwide survey of clinical characteristics, management, and outcomes of acute kidney injury (AKI) - patients with and without preexisting chronic kidney disease have different prognoses.
Acute kidney injury (AKI) is a common complication in hospitalized patients. The International Society of Nephrology implemented the "0 by 25" initiative aimed at preventing deaths from treatable AKI worldwide by 2025 and conducted a global snapshot survey in 2014. We joined in the project and conducted this study to compare the epidemiology, risk factors, and prognosis between patients with pure AKI and those with acute-on-chronic kidney disease (ACKD). In this study, we prospectively collected demographic parameters and data on clinical characteristics, baseline comorbidities, management, and outcomes of 201 AKI patients in 18 hospitals in Taiwan from September 2014 to November 2014. The in-hospital mortality rate was 16%. AKI was mostly attributed to sepsis (52%). Multivariate logistic regression indicated that oliguria was a positive independent predictor of in-hospital mortality, whereas preexisting CKD and exposure to nephrotoxic agents were negative independent predictors. The prevalence of vasopressor use, intensive care unit care, and mortality were significantly higher in pure AKI patients than in ACKD patients. Moreover, serum creatinine (SCr) levels significantly increased within 7 days after AKI diagnosis in nonsurvivors but not in survivors in the pure AKI group. By contrast, SCr levels were persistently lower in nonsurvivors than in survivors in the ACKD group during the same period. We thus determined that the prognosis of ACKD patients differed from that of pure AKI patients. Considering the CKD history in the future AKI staging system may improve prognosis prediction.
aDivision of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung bDivision of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital cDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei dDivision of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung eDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin fDivision of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong; and Saint Mary's Medicine, Nursing and Management College, Yilan gDivision of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; and Chang Gung University College of Medicine, Taoyuan hDivision of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei iDivision of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan jDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Hisn-Chu Branch, Hsin-Chu City kKidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital; and Chang Gung University College of Medicine, Taoyuan lDivision of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan (R.O.C.).
Heng-Chih
HC
Pan
Pei-Chen
PC
Wu
Vin-Cent
VC
Wu
Ya-Fei
YF
Yang
Tao-Min
TM
Huang
Chih-Chung
CC
Shiao
Te-Chuan
TC
Chen
Der-Cherng
DC
Tarng
Jui-Hsiang
JH
Lin
Wei-Shun
WS
Yang
Chiao-Yin
CY
Sun
Chan-Yu
CY
Lin
Tzong-Shinn
TS
Chu
Mai-Szu
MS
Wu
Kwan-Dun
KD
Wu
Yung-Chang
YC
Chen
Chiu-Ching
CC
Huang
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
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