title: Community-Acquired Acute Kidney Injury: A Nationwide Survey in China.
abstract: BACKGROUND
  This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI.
  
  
  METHODS
  Cross-sectional and retrospective study.
  
  
  METHODS
  A national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission.
  
  
  METHODS
  The rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted.
  
  
  RESULTS
  All-cause in-hospital mortality and recovery of kidney function at hospital discharge.
  
  
  RESULTS
  4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor.
  
  
  CONCLUSIONS
  Possible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine.
  
  
  CONCLUSIONS
  The features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources.
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
authors.forename: Yafang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Wang
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
authors.forename: Tao
authors.initials: T
authors.lastname: Su
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Qu
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Zhao
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China. Electronic address: li.yang@bjmu.edu.cn.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000378:metabolism; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003404:Creatinine
keywords: Acute kidney injury (AKI); China; community-acquired AKI; decreased kidney perfusion; etiology; health disparities; incidence; mortality; nationwide survey; per capita gross domestic product; regional variation; renal replacement therapy (RRT); serum creatinine