Community-Acquired Acute Kidney Injury at Hospital Admission: What Happens One Year After?

Abstract

Community-acquired acute kidney injury is a frequent diagnosis at hospital admission in developed countries. Due to the multiple comorbidities, patients admitted to internal medicine departments have a higher susceptibility to acute kidney injury. To determine the prevalence, risk factors, and impact of community-acquired acute kidney injury, we developed a retrospective observational case-control study in an internal medicine ward at a tertiary hospital comparing patients admitted with community-acquired acute kidney injury with patients without acute kidney injury at hospital admission. Patients who needed dialysis were excluded. Community-acquired acute kidney injury was present in 19.6% of patients, mostly prerenal acute kidney injury (68.8%) and Kidney Disease Improving Global Outcomes classification stage 1 (51.9%). Dementia (OR 3.3, [0.2–0.6]) and loop diuretics as outpatient medication (OR 2.2, [0.2–0.9]) were risk factors for community-acquired acute kidney injury. These patients presented higher mortality after hospital discharge (p=0.003), and 35.1% of deaths occurred in the first 90 days. At one-year follow-up, chronic kidney disease progression was more frequent in the community-acquired acute kidney injury group (24.6% versus 2.6%, p=0.002); otherwise, new-onset chronic kidney disease was similar between groups. The long-term consequences of community-acquired acute kidney injury can be severe, including renal disease progression and mortality after hospital discharge (mostly in the first 90 days); thus, it is important to implement programs to provide early evaluation for these patients. Patients taking diuretics are at increased risk of acute kidney injury. Also, patient and caregiver education on hydration of demented patients could prevent community-acquired acute kidney injury.