Abstract
Acute kidney injury (AKI) is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding) or improvements to the management of AKI.
Highlights
Acute kidney injury (AKI) is a serious condition characterized by a sudden decline in kidney function, leading to inept excretion of nitrogenous waste from the body and deficient serum volume and electrolyte regulation
Significant differences were observed in all AKI patient characteristics except for sex, age, chronic pulmonary disease, and diabetes with chronic complications
While we found a downward trend in the proportion of AKI patients with hospital mortality, the raw number of deaths and attributable population risk of death for AKI increased significantly from 2001 to 2011
Summary
Acute kidney injury (AKI) is a serious condition characterized by a sudden decline in kidney function, leading to inept excretion of nitrogenous waste from the body and deficient serum volume and electrolyte regulation. Acute tubular necrosis (ATN) caused by ischemia, exposure to nephrotoxic agents (e.g., medications and contrast media), or sepsis is the leading cause of AKI among hospitalized patients in the US [2]. Patients at risk for AKI include those with advanced age, diabetes mellitus, heart failure, liver failure, chronic kidney disease, hypotension, and sepsis. Patients who undergo cardiac/vascular surgery, organ transplantation, and mechanical ventilation or who are exposed to contrast media, nonsteroidal-inflammatory drugs (NSAIDs), antimicrobial drugs, or chemotherapeutic agents commonly experience AKI as a complicating condition [3]. Patients that experience AKI are at increased risk for adverse health outcomes such as end stage renal disease (ESRD), pulmonary complications, and cardiovascular events [6,7,8,9]. AKI severity is positively associated with patient morbidity and mortality [11, 12]
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