Incidence and prognosis of acute kidney injury versus acute kidney disease among 71,041 inpatients
Lingyu Xu, Chenyu Li, Na Li, Long Zhao, Zhihui Zhu, Xiaosu Zhang, Jing Wang, Jun Zhao, Junyan Huang, Zhihua Zheng, Hans-Joachim Anders, Yan Xu- Transplantation
- Nephrology
Abstract
Background
Acute kidney disease (AKD) defines patients with acute kidney injury (AKI) or subacute loss of kidney function lasting for more than 7 days. Little is known about the prognosis of AKD in hospitalized patients.
Objective
The aim of this study was to investigate the risk factors and prognosis of AKD and to compare different types of acute/subacute renal impairment among Chinese inpatients.
Methods
Complete data were available from 71 041 patients for a range of 5–63 months. AKI and AKD were diagnosed based on the Acute Disease Quality Initiative Criteria 2017.
Results
Of 71 041 inpatients, 16 098 (22.7%) patients developed AKI or AKD. 5 895 (8.3%) AKI patients recovered within 7 days, 5 623 (7.9%) AKI patients were followed by AKD and 4 580 (6.4%) patients developed AKD without AKI. Mortality was proportional to stages of AKI and AKD (P < 0.05), while AKI followed by AKD was associated with a higher risk of long-term mortality (hazard ratio (HR) 4.51) as compared to AKD without AKI (HR 2.25) and AKI recover (HR 1.18). The AKD criterion was robustly associated with overall survival (area under the receiver operating characteristic curve (AUROC) 0.71) and de novo CKD (AUROC 0.71), while AKI criterion showed a relatively lower ability to fitting risk of overall survival (AUROC 0.65) and CKD (AUROC 0.63).
Conclusions
AKD and AKD stages are useful clinical definitions for clinical practice as they predict unfortunate clinical outcomes, such as overall long-term mortality and CKD. Research activities should also focus on AKD.