Epidemiology of acute kidney injury: how big is the problem? Crit Care Med 36(4):S146-S151

Intensive Care Unit, Ghent University Hospital, Ghent, Belgium.
Critical care medicine (Impact Factor: 6.31). 05/2008; 36(4 Suppl):S146-51. DOI: 10.1097/CCM.0b013e318168c590
Source: PubMed


Acute kidney injury (AKI) is a complication that occurs frequently in hospitalized patients. In this article, we provide an overview of the literature on the epidemiology of AKI in hospitalized patients.
The overview is restricted to hospitalized patients, and most emphasis is put on intensive care unit patients.
The population incidence of less severe AKI and AKI treated with renal replacement therapy is approximately 2,000-3,000 and 200-300 per million population per year, respectively. These numbers are comparable with the estimates for severe sepsis and acute lung injury. Approximately 4-5% of general intensive care unit patients will be treated with renal replacement therapy, and up to two thirds of intensive care unit patients will develop AKI defined by the RIFLE classification. The incidence of AKI is increasing. Intensive care unit patients with AKI have a longer length of stay and therefore generate greater costs. In addition, AKI is associated with increased mortality, even after correction for covariates. Increasing RIFLE class is associated with increasing risk of in-hospital death. Patients with AKI who are treated with renal replacement therapy still have a mortality rate of 50-60%. Of surviving patients, 5-20% remain dialysis dependent at hospital discharge.
AKI has a high incidence, comparable with acute lung injury and severe sepsis, and is associated with higher hospital mortality.

Download full-text


Available from: Eric Hoste, Feb 04, 2015
  • Source
    • "Acute kidney injury (AKI) is a common complication in hospitalized patients [1] [2] [3] [4]. Despite progress in medical care, it is still associated with increased morbidity, mortality, length of hospital stay, costs, and postacute care resource utilization [4] [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Early diagnosis of acute kidney injury (AKI) at emergency department (ED) is a challenging issue. Current diagnostic criteria for AKI poorly recognize early renal dysfunction and may cause delayed diagnosis. We evaluated the use of serum cystatin C (CysC) for the early and accurate diagnosis of AKI in patients hospitalized from the ED. Methods: In a total of 198 patients (105 males and 93 females), serum CysC, serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were calculated at 0, 6, 12, 24, 48, and 72 hours after presentation to the ED. We compared two groups according to the presence or absence of AKI. Results: Serial assessment of CysC, sCr, and eGFR was not a strong, reliable tool to distinguish AKI from non-AKI. CysC > 1.44 mg/L at admission, both alone (Odds Ratio = 5.04; 95%CI 2.20-11.52; P < 0.0002) and in combination with sCr and eGFR (Odds Ratio = 5.71; 95%CI 1.86-17.55; P < 0.002), was a strong predictor for the risk of AKI. Conclusions: Serial assessment of CysC is not superior to sCr and eGFR in distinguishing AKI from non-AKI. Admission CysC, both alone and in combination with sCr and eGFR, could be considered a powerful tool for the prediction of AKI in ED patients.
    Full-text · Article · Jul 2015 · Disease markers
  • Source
    • "Acute kidney injury (AKI) is an important disorder and is associated with poor clinical outcomes and increased costs [1] [2] [3] [4]. The incidence in hospitalized patients of mild AKI and AKI treated with renal replacement therapy is ~ 2,000 – 3,000 and 200 – 300 per million populations per year, respectively, accounting for ~ 5 – 20% of all hospitalized patients [5] [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aims: Acute kidney injury (AKI) occurs in up to 40% of patients undergoing cardiac surgery. Proenkephalin A 119-159 (pro-ENK) is a novel, stable surrogate biomarker for enkephalins, endogenous opioids involved in various physiological processes, including neurohormonal stress. Material and methods: 92 patients undergoing cardiac surgery at the Veterans Affairs San Diego Healthcare System had a post-hoc analysis performed to determine the ability of pro-ENK to predict AKI as well as to compare it against other risk factors for development of AKI. Results: Of 92 patients, 20 patients developed AKI post-operatively. Pro-ENK levels were significantly elevated in patients who develop AKI. Log pro-ENK value pre-operatively has an odds ratio of 23.8 (p = 0.011, 95% CI = 2 - 270) in its association with AKI. Pro-ENK performs similarly to baseline creatinine in its ability to predict post-operative AKI. Importantly, pro-ENK has a strong positive correlation with creatinine (r = 0.806). Additionally, changes in pro-ENK level, from pre-operatively to 12 hours post-operatively have greatest area under curve by ROC analysis for AKI after post-operative day 1. Conclusion: Pro-ENK is associated with prediction of AKI in patients undergoing cardiac surgery. Pro-ENK likely has decreased clearance in the setting of AKI. However, future studies analyzing this novel biomarker should be considered to further elucidate its clinical utility and to better understand mechanisms of renal injury.
    Full-text · Article · Jan 2015 · Clinical nephrology
  • Source
    • "On the clinical side, prevention and therapy of AKI and CKD largely rely on empirical knowledge. With an increasing incidence of AKI in all acute care hospitalizations , risk assessment strategies and therapeutic options are limited (Chertow et al. 2005, Ali et al. 2007, Hoste & Schurgers 2008, Thakar et al. 2009, Thakar 2013). Translational approaches – although urgently warranted – are still scarce (Zarjou et al. 2012, Evans et al. 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Renal tissue hypoperfusion and hypoxia are key elements in the pathophysiology of acute kidney injury and its progression to chronic kidney disease. Yet, in vivo assessment of renal haemodynamics and tissue oxygenation remains a challenge. Many of the established approaches are invasive, hence not applicable in humans. Blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) offers an alternative. BOLD-MRI is non-invasive and indicative of renal tissue oxygenation. Nonetheless recent (pre-)clinical studies revived the question as to how bold renal BOLD-MRI really is. This review aims to deliver some answers. It is designed to inspire the renal physiology, nephrology, and imaging communities to foster explorations into the assessment of renal oxygenation and haemodynamics by exploiting the powers of MRI. For this purpose the specifics of renal oxygenation and perfusion are outlined. The fundamentals of BOLD-MRI are summarized. The link between tissue oxygenation and the oxygenation sensitive MR biomarker T2* is outlined. The merits and limitations of renal BOLD-MRI in animal and human studies are surveyed together with their clinical implications. Explorations into detailing the relation between renal T2* and renal tissue partial pressure of oxygen (pO2) are discussed with a focus on factors confounding the T2* versus tissue pO2 relation. Multi-modality in vivo approaches suitable for detailing the role of the confounding factors that govern T2* are considered. A schematic approach describing the link between renal perfusion, oxygenation, tissue compartments and renal T2* is proposed. Future directions of MRI assessment of renal oxygenation and perfusion are explored.This article is protected by copyright. All rights reserved.
    Full-text · Article · Sep 2014 · Acta Physiologica
Show more