Abstract
BackgroundAcute kidney injury (AKI) places a heavy burden on the healthcare system in China and is usually misdiagnosed. However, there are limited studies that have described the epidemiology and diagnosis of AKI in China. The aim of this study was to describe the incidence and diagnosis of AKI in hospitalized adult patients in a tertiary teaching hospital in southeast China.MethodsAll adult patients hospitalized from October 1, 2013 to September 30, 2014 in the First Affiliated Hospital of Nanjing Medical University were screened using the Lab Administration Network. AKI definition and staging were based on the KDIGO AKI criteria. Demographic characteristics, laboratory examination, clinical data, and clinical outcomes of AKI patients were recorded and analyzed.ResultsThe incidence of AKI was 1.6% (1401/87196). The 30-day mortality was 35.3%. AKI stage 1, 2, 3 and RRT accounted for 38.0% (532/1401), 22.0% (309/1401), 40.0% (560/1401), and 16.3% (228/1401) of patients, respectively. The Renal, other Internal Medicine, Surgery, and ICU Departments accounted for 7.4%, 37.1%, 30.1%, and 25.4% of AKI patients, respectively. The timely diagnosis rate, delayed diagnosis rate, and missed diagnosis rate were 44% (616/1401), 3.3% (46/1401), and 52.7% (739/1401), respectively. Patients hospitalized in the Renal Department had the highest AKI diagnosis rate (89.3%, 88/103), while missed diagnosis rate of the surgical patients was as high as 75.1% (317/422). Multivariable logistic regression analysis indicated that presence of tumors, higher serum albumin, and AKI stage 1 were associated with failure to timely diagnose AKI, whereas presence of chronic kidney disease, oliguria, higher blood urea nitrogen, and greater number of organ failures correlated with earlier diagnosis.ConclusionsAKI was characterized by a high incidence, high short-term mortality, and high missed diagnosis rate in hospitalized adult patients in our hospital. Interventions for improving diagnosis of AKI are urgently needed.
Highlights
Acute kidney injury (AKI) places a heavy burden on the healthcare system in China and is usually misdiagnosed
The results indicated that age, presence of chronic liver disease, oliguria, extra-renal organ failure, malignancy, and chronic pulmonary diseases were independent risk factors for 30-day mortality in hospitalized patients with AKI (Additional file 1: Table S2), and that age, presence of extra-renal organ failure, higher AKI stage, presence of oliguria, receiving renal replacement therapy (RRT), no prior surgery, higher total bilirubin, and lower hemoglobin and lower serum albumin were independent risk factors for loss of renal
Univariate (Additional file 1: Table S5) and crude multivariate (Table 4) logistic regression analysis showed that presence of tumors, higher serum albumin, and AKI stage 1 were associated with failure to timely diagnose AKI, while presence of chronic kidney disease (CKD), presence of oliguria, higher blood urea nitrogen, and greater number of organ failures correlated with timely diagnosis
Summary
Acute kidney injury (AKI) places a heavy burden on the healthcare system in China and is usually misdiagnosed. There are limited studies that have described the epidemiology and diagnosis of AKI in China. Acute kidney injury (AKI) is a common complication in hospitalized patients that is characterized by a high incidence, high mortality, poor renal prognosis, and increased medical costs [1,2,3]. In China, the largest developing country in the world with about 20% of the global population and unbalanced development across regions, AKI occurred in 1.0%–10.7% of hospitalized patients and placed a heavy burden on the healthcare system in China as well as all other countries [5, 6]. Reports on the epidemiology and diagnosis of AKI remain deficient [5, 6, 8,9,10,11,12]
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