Acute kidney injury burden in different clinical units: Data from nationwide survey in China.
BACKGROUND
The inpatient morbidity and mortality of acute kidney injury (AKI) vary considerably in different clinical units, yet studies to compare the difference remain limited.


METHODS
We compared the clinical characteristics of AKI in Intensive Care Unit (ICU), medical and surgical departments by using the data derived from the 2013 nationwide cross-sectional survey of AKI in China to capture variations among different clinical departments in recognition, management, and outcomes of AKI. Suspected AKI patients were identified based on changes in serum creatinine during hospitalization, and confirmed by reviewing medical records.


RESULTS
The detection rate of AKI was the highest in ICU (22.46%), followed by the rates in medical (1.96%) and surgical departments (0.96%). However, the absolute number of cases was the largest in medical departments, which contributed to 50% of the cases. In medical departments, 78% of AKI cases were extensively distributed in cardiac, nephrology, oncology, gastroenterology, pneumology and neurology departments. In contrast, 87% of AKI cases in surgical departments were mainly from urology, general surgery and cardiothoracic departments. The in-time recognition rates were extremely low in all departments except nephrology. Only 10.5~15.0% AKI patients from non-nephrology departments received renal referral. Among all the death cases, 50% and 39% came from ICU and medical departments while only 11% from surgical departments. Older age, higher AKI stage and renal replacement therapy indication were identified as risk factors for high mortality in all departments. Delayed recognition and no renal referral were significantly associated with increased mortality in medical and ICU patients.


CONCLUSIONS
These findings suggest that ICU and medical departments are major affected departments in China with a large number of AKI cases and subsequent high mortality. The reality is more alarming considering the low awareness of AKI and the paucity of effective interventions in the high-risk patients in these departments.
Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Xiaojing
X
Tang
Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Dongping
D
Chen
Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Shengqiang
S
Yu
Renal Division, Peking University First Hospital, Beijing, China.
Li
L
Yang
Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Changlin
C
Mei
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
D003404:Creatinine