Li Yang1, Guolan Xing2, Li Wang3, Yonggui Wu4, Suhua Li5, Gang Xu6, Qiang He7, Jianghua Chen8, Menghua Chen9, Xiaohua Liu10, Zaizhi Zhu11, Lin Yang15, Xiyan Lian13, Feng Ding14, Yun Li15, Huamin Wang16, Jianqin Wang17, Rong Wang18, Changlin Mei19, Jixian Xu20, Rongshan Li21, Juan Cao22, Liang Zhang23, Yan Wang24, Jinhua Xu25, Beiyan Bao26, Bicheng Liu27, Hongyu Chen28, Shaomei Li29, Yan Zha30, Qiong Luo31, Dongcheng Chen32, Yulan Shen33, Yunhua Liao34, Zhengrong Zhang35, Xianqiu Wang36, Kun Zhang37, Luojin Liu38, Peiju Mao39, Chunxiang Guo40, Jiangang Li41, Zhenfu Wang42, Shoujun Bai43, Shuangjie Shi44, Yafang Wang45, Jinwei Wang45, Zhangsuo Liu2, Fang Wang3, Dandan Huang4, Shun Wang5, Shuwang Ge6, Quanquan Shen7, Ping Zhang8, Lihua Wu9, Miao Pan10, Xiting Zou11, Ping Zhu12, Jintao Zhao13, Minjie Zhou14, Lin Yang15, Wenping Hu46, Jing Wang17, Bing Liu18, Tong Zhang19, Jianxin Han20, Tao Wen21, Minghui Zhao45, Haiyan Wang45. 1. Peking University First Hospital, Beijing, China. Electronic address: li.yang@bjmu.edu.cn. 2. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 3. Sichuan Provincial People's Hospital, Chengdu, China. 4. The First Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China. 5. The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. 6. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 7. Zhejiang Provincial People's Hospital, Hangzhou, China. 8. The First Affiliated Hospital of Zhejiang University, Hangzhou, China. 9. General Hospital of Ningxia Medical University, Yinchuan, China. 10. Ningde Municipal Hospital, Fujian Medical University, Ningde, China. 11. Meishan City People's Hospital, Meishan, China. 12. The First College of Clinical Medical Science, China Three Gorges University, Yichang, China. 13. The Second Affiliated Hospital of Kunming Medical University, Kunming, China. 14. Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China. 15. Jiangxi Provincial People's Hospital, Nanchang, China. 16. Peking University First Hospital, Beijing, China; The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China. 17. Lanzhou University Second Hospital, Lanzhou, China. 18. Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 19. Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, China. 20. Renshou County People's Hospital, Renshou, China. 21. The Affiliated Provincial People's Hospital of Shanxi Medical University, Taiyuan, China. 22. Taixing People's Hospital, Taixing, China. 23. Ordos Central Hospital, Ordos, Inner Mongolia, China. 24. Xinganmeng People's Hospital, Wulanhaote, Inner Mongolia, China. 25. Fuyang City People's Hospital, Fuyang, Zhejiang, China. 26. Ningbo Yinzhou Second Hospital, Ningbo, China. 27. Zhongda Hospital, Southeast University, Nanjing, China. 28. Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China. 29. The Second Hospital of Hebei Medical University, Shijiazhuang, China. 30. Guizhou Provincial People's Hospital, Guizhou Medical University, Guiyang, China. 31. Peking University Shenzhen Hospital, Shenzhen, China. 32. Hengxian People's Hospital, Hengxian, China. 33. Miyun County Hospital, Beijing, China. 34. The First Affiliated Hospital of Guangxi Medical University, Nanning, China. 35. Puer City People's Hospital, Puer, China. 36. Zoucheng City People's Hospital, Zoucheng, China. 37. Taihe Hospital of Traditional Chinese Medicine, Taihe, China. 38. Shenzhen Longhua New District Central Hospital, Shenzhen, China. 39. Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China. 40. Zhongwei City People's Hospital, Zhongwei, China. 41. Huaxian People's Hospital, Huaxian, China. 42. Suihua City First Hospital, Suihua, China. 43. Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China. 44. Qingxuxian City People's Hospital, Qingxu, China. 45. Peking University First Hospital, Beijing, China. 46. The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
Abstract
BACKGROUND: Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. METHODS: We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics. FINDINGS: Of 2,223,230 patients admitted to the 44 hospitals screened in 2013, 154,950 (7·0%) were suspected of having AKI by electronic screening, of whom 26,086 patients (from 374,286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374,286) by KDIGO criteria and 2·03% (7604 of 374,286) by expanded criteria, from which we estimate that 1·4-2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality INTERPRETATION: AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI. FUNDING: National 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee.
BACKGROUND:Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. METHODS: We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics. FINDINGS: Of 2,223,230 patients admitted to the 44 hospitals screened in 2013, 154,950 (7·0%) were suspected of having AKI by electronic screening, of whom 26,086 patients (from 374,286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374,286) by KDIGO criteria and 2·03% (7604 of 374,286) by expanded criteria, from which we estimate that 1·4-2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality INTERPRETATION: AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI. FUNDING: National 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee.
Authors: Michael Haase; Andreas Kribben; Walter Zidek; Jürgen Floege; Christian Albert; Berend Isermann; Bernt-Peter Robra; Anja Haase-Fielitz Journal: Dtsch Arztebl Int Date: 2017-01-09 Impact factor: 5.594
Authors: Chih-Wei Yang; David C H Harris; Valerie A Luyckx; Masaomi Nangaku; Fan Fan Hou; Guillermo Garcia Garcia; Hasan Abu-Aisha; Abdou Niang; Laura Sola; Sakarn Bunnag; Somchai Eiam-Ong; Kriang Tungsanga; Marie Richards; Nick Richards; Bak Leong Goh; Gavin Dreyer; Rhys Evans; Henry Mzingajira; Ahmed Twahir; Mignon I McCulloch; Curie Ahn; Charlotte Osafo; Hsiang-Hao Hsu; Lianne Barnieh; Jo-Ann Donner; Marcello Tonelli Journal: Kidney Int Suppl (2011) Date: 2020-02-19