Original Investigation
Community-Acquired Acute Kidney Injury: A Nationwide Survey in China

https://doi.org/10.1053/j.ajkd.2016.10.034Get rights and content

Background

This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI.

Study Design

Cross-sectional and retrospective study.

Setting & Participants

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.

Predictors

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.

Outcomes

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.

Limitations

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.

Section snippets

Participants and Survey Protocol

The study was approved by the Ethics Committee of Peking University First Hospital, and the requirement for informed consent was waived due to the retrospective nature of the study (2014[729]). The survey protocol has previously been described in detail.5 Altogether in 2013, there were 2,223,230 hospitalized adults (aged ≥ 18 years) from 22 academic hospitals and 22 local hospitals in Mainland China who were screened for suspected AKI based on changes in serum creatinine (Scr) levels through

Overview of Community-Acquired AKI Cases

Among the 374,286 patients who were admitted to the hospital during either of the 2 months studied (January and July 2013), AKI was defined in 7,604 cases, of which 4,136 were identified as community-acquired AKI. The detected rate of community-acquired AKI among adult hospitalizations was 1.11% (4,136 of 374,286), and the proportion of community-acquired AKI cases among all AKI cases was 54.4% (4,136 of 7,604; Tables 1 and 2).

Characteristics of Patients With Community-Acquired AKI

Mean age of patients with CA-AKI was 61.2 ± 17.9 (standard deviation)

Discussion

Systemic reports on community-acquired AKI are limited worldwide.15, 16 The recommended AKI definitions7 focus on the rapid increase in Scr level or a decrease in urine output within a short period and thus can be easily applied to patients who develop AKI during hospitalization, but are less applicable for community-acquired AKI cases in which kidney injury occurs outside hospitals, and the patients may have experienced a sharp increment in Scr levels before admission.1 In the current study,

Acknowledgements

We thank the members of the ISN AKF 0by25 China Consortium, which comprises Peking University First Hospital, Beijing, China (Li Yang, MD, Yafang Wang, MD, Jinwei Wang, PhD, M. Zhao, MD, and Haiyan Wang, MD); The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G. Xing, MD, and Z. Liu, MD); Sichuan Provincial People’s Hospital, Chengdu, China (L. Wang, MD, and F. Wang, MD); The First Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China (Y. Wu, MD, and D.

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