J Holmes1, J Geen2,3, B Phillips4, J D Williams4, A O Phillips4. 1. Welsh Renal Clinical Network, Cwm Taf University Health Board, UK. 2. Department of Clinical Biochemistry, Cwm Taf University Health Board, Merthyr, UK. 3. Faculty of Life Sciences and Education, University of South Wales, UK. 4. Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
Abstract
BACKGROUND: The extent of patient contact with medical services prior to development of community acquired-acute kidney injury (CA-AKI)is unknown. AIM: We examined the relationship between incident CA-AKI alerts, previous contact with hospital or primary care and clinical outcomes. DESIGN: A prospective national cohort study of all electronic AKIalerts representing adult CA-AKI. METHODS: Data were collected for all cases of adult (≥18 years of age) CA-AKI in Wales between 1 November 2013 and 31 January 2017. RESULTS: There were a total of 50 560 incident CA-AKI alerts. In 46.8% there was a measurement of renal function in the 30 days prior to the AKI alert. In this group, in 63.8% this was in a hospital setting, of which 37.6% were as an inpatient and 37.5% in Accident and Emergency. Progression of AKI to a higher AKI stage (13.1 vs. 9.8%, P < 0.001) (or for AKI 3 an increase of > 50% from the creatinine value generating the alert), the proportion of patients admitted to Intensive Care (5.5 vs. 4.9%, P = 0.001) and 90-day mortality (27.2 vs. 18.5%, P < 0.001) was significantly higher for patients with a recent test. 90-day mortality was highest for patients with a recent test taken in an inpatient setting prior to CA-AKI (30.9%). CONCLUSION: Almost half of all patients presenting with CA-AKI are already known to medical services, the majority of which have had recent measurement of renal function in a hospital setting, suggesting that AKI for at least some of these may potentially be predictable and/or avoidable.
BACKGROUND: The extent of patient contact with medical services prior to development of community acquired-acute kidney injury (CA-AKI)is unknown. AIM: We examined the relationship between incident CA-AKI alerts, previous contact with hospital or primary care and clinical outcomes. DESIGN: A prospective national cohort study of all electronic AKIalerts representing adult CA-AKI. METHODS: Data were collected for all cases of adult (≥18 years of age) CA-AKI in Wales between 1 November 2013 and 31 January 2017. RESULTS: There were a total of 50 560 incident CA-AKI alerts. In 46.8% there was a measurement of renal function in the 30 days prior to the AKI alert. In this group, in 63.8% this was in a hospital setting, of which 37.6% were as an inpatient and 37.5% in Accident and Emergency. Progression of AKI to a higher AKI stage (13.1 vs. 9.8%, P < 0.001) (or for AKI 3 an increase of > 50% from the creatinine value generating the alert), the proportion of patients admitted to Intensive Care (5.5 vs. 4.9%, P = 0.001) and 90-day mortality (27.2 vs. 18.5%, P < 0.001) was significantly higher for patients with a recent test. 90-day mortality was highest for patients with a recent test taken in an inpatient setting prior to CA-AKI (30.9%). CONCLUSION: Almost half of all patients presenting with CA-AKI are already known to medical services, the majority of which have had recent measurement of renal function in a hospital setting, suggesting that AKI for at least some of these may potentially be predictable and/or avoidable.
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