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. 2024 Jul 22;17(8):sfae231.
doi: 10.1093/ckj/sfae231. eCollection 2024 Aug.

Recognition patterns of acute kidney injury in hospitalized patients

Pasquale Esposito  1   2 , Francesca Cappadona  1   2 , Marita Marengo  3 , Marco Fiorentino  4 , Paolo Fabbrini  5 , Alessandro Domenico Quercia  3 , Francesco Garzotto  6 , Giuseppe Castellano  7 , Vincenzo Cantaluppi  8 , Francesca Viazzi  1   2
Affiliations

Recognition patterns of acute kidney injury in hospitalized patients

Pasquale Esposito et al. Clin Kidney J. .

Abstract

Background: Acute kidney injury (AKI) during hospitalization is associated with increased complications and mortality. Despite efforts to standardize AKI management, its recognition in clinical practice is limited.

Methods: To assess and characterize different patterns of AKI diagnosis, we collected clinical data, serum creatinine (sCr) levels, comorbidities and outcomes from adult patients using the Hospital Discharge Form (HDF). AKI diagnosis was based on administrative data and according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria by evaluating sCr variations during hospitalization. Additionally, patients were categorized based on the timing of AKI onset.

Results: Among 56 820 patients, 42 900 (75.5%) had no AKI, 1893 (3.3%) had AKI diagnosed by sCr changes and coded in the HDF (full-AKI), 2529 (4.4%) had AKI reported on the HDF but not meeting sCr-based criteria (HDF-AKI) and 9498 (16.7%) had undetected AKI diagnosed by sCr changes but not coded in the HDF (KDIGO-AKI). Overall, AKI incidence was 24.5%, with a 68% undetection rate. Patients with KDIGO-AKI were younger and had a higher proportion of females, lower comorbidity burden, milder AKI stages, more frequent admissions to surgical wards and lower mortality compared with full-AKI patients. All AKI groups had worse outcomes than those without AKI, and AKI, even if undetected, was independently associated with mortality risk. Patients with AKI at admission had different profiles and better outcomes than those developing AKI later.

Conclusions: AKI recognition in hospitalized patients is highly heterogeneous, with a significant prevalence of undetection. This variability may be affected by patients' characteristics, AKI-related factors, diagnostic approaches and in-hospital patient management. AKI remains a major risk factor, emphasizing the importance of ensuring proper diagnosis for all patients.

Keywords: AKI; administrative data; diagnosis; mortality; serum creatinine.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:
Selection strategy for the definition of AKI recognition patterns among patients hospitalized during the study period (2016–2019).
Figure 2:
Figure 2:
AKI pattern distribution among patients hospitalized during the study period (2016–2019).
Figure 3:
Figure 3:
30-day Kaplan–Meier survival estimation based on AKI recognition patterns.
Figure 4:
Figure 4:
30-day Kaplan–Meier survival estimation based on timing of AKI onset. Only patients with biochemical diagnosis of AKI based on sCr changes (n = 11 391) were included in this analysis.
See this image and copyright information in PMC

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