Epidemiology and Clinical Outcomes of Community-Acquired Acute Kidney Injury in the Emergency Department: A Multisite Retrospective Cohort Study
Abstract
RATIONALE & OBJECTIVE
The prevalence of community-acquired AKI (CA-AKI) in the United States (US) and its clinical consequences are not well described. Our objective was to describe the epidemiology and clinical outcomes associated with CA-AKI.
STUDY DESIGN
Retrospective cohort study.
SETTING & PARTICIPANTS
The study included 178,927 encounters by 139,632 adults at five US emergency departments (EDs) between 7/1/17 and 12/31/22.
PREDICTORS
CA-AKI, identified using KDIGO serum creatinine (sCr) based criteria.
OUTCOMES
For encounters resulting in hospitalization, the in-hospital trajectory of AKI severity, dialysis initiation, intensive care unit (ICU) admission, and death. For all encounters, occurrence over 180 days of hospitalization, ICU admission, new or progressive CKD, dialysis initiation, and death.
ANALYTICAL APPROACH
Multivariable logistic regression analysis to test the association between CA-AKI and measured outcomes.
RESULTS
For all encounters, 10.4% of patients met the criteria for any stage of AKI on arrival to the ED. 16.6% of patients admitted to the hospital from the ED had CA-AKI on arrival to the ED. The likelihood of AKI recovery was inversely related to CA-AKI stage on arrival to the ED. Among encounters for hospitalized patients, CA-AKI was associated with in-hospital dialysis initiation (OR 6.2, 95% CI 5.1-7.5), ICU admission (OR 1.9, 95% CI 1.7-2.0), and death (OR 2.2, 95% CI 2.0-2.5) compared to those without CA-AKI. Among all encounters, CA-AKI was…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 139,632 participants or records.
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