BACKGROUND: Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers. METHODS: In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality. RESULTS: Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers. CONCLUSIONS: In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.
BACKGROUND: Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers. METHODS: In this cohort study of critically illpatients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality. RESULTS: Of the 15,132 critically illpatients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers. CONCLUSIONS: In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.
Authors: Kianoush Kashani; Min Shao; Guangxi Li; Amy W Williams; Andrew D Rule; Walter K Kremers; Michael Malinchoc; Ognjen Gajic; John C Lieske Journal: Kidney Int Date: 2017-05-18 Impact factor: 10.612
Authors: Anitha Vijayan; Emaad M Abdel-Rahman; Kathleen D Liu; Stuart L Goldstein; Anupam Agarwal; Mark D Okusa; Jorge Cerda Journal: Clin J Am Soc Nephrol Date: 2021-08-30 Impact factor: 10.614
Authors: Kianoush Kashani; Mitchell Howard Rosner; Michael Haase; Andrew J P Lewington; Donal J O'Donoghue; F Perry Wilson; Mitra K Nadim; Samuel A Silver; Alexander Zarbock; Marlies Ostermann; Ravindra L Mehta; Sandra L Kane-Gill; Xiaoqiang Ding; Peter Pickkers; Azra Bihorac; Edward D Siew; Erin F Barreto; Etienne Macedo; John A Kellum; Paul M Palevsky; Ashita Jiwat Tolwani; Claudio Ronco; Luis A Juncos; Oleksa G Rewa; Sean M Bagshaw; Theresa Ann Mottes; Jay L Koyner; Kathleen D Liu; Lui G Forni; Michael Heung; Vin-Cent Wu Journal: Clin J Am Soc Nephrol Date: 2019-05-17 Impact factor: 8.237
Authors: M Joannidis; W Druml; L G Forni; A B J Groeneveld; P M Honore; E Hoste; M Ostermann; H M Oudemans-van Straaten; M Schetz Journal: Intensive Care Med Date: 2017-06-02 Impact factor: 17.440