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Kidney Week

Abstract: SA-PO539

AKI in Patients with Hip Fracture: A Single Centre Experience

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Forbes, Anna K., Epsom and St Helier NHS Trust, Carshalton, United Kingdom
  • Singh, Nivi, Epsom and St Helier NHS Trust, Carshalton, United Kingdom
  • Sood, Bhrigu Raj, Epsom and St Helier NHS Trust, Carshalton, United Kingdom
Background

Hip fracture is the most common serious injury in the elderly associated with high morbidity and mortality. These patients are high risk of developing acute kidney injury (AKI). We evaluated the incidence of AKI occurring anytime during admission and impact on length of stay (LoS) and mortality in patients admitted with hip fracture. St Helier Hospital Hip Fracture Unit is the best performing and second busiest in London according to the Department of Health’s Best Practice Tariff. We sought to establish if this good practice translated to reduced AKI incidence and improved outcomes.

Methods

This is a retrospective observational study of patients presenting to St Helier Hospital Hip Fracture Unit between January 2015 and December 2016. Patients were identified from the National Hip Fracture Database. AKI was identified from electronic pathology alerts and defined according to Kidney Disease Improving Global Outcomes criteria.

Results

861 patients presented with hip fracture; 246 males (28.6%) and 615 females (71.4%). Mean age was 83.4 years (60-104 years) and median LoS was 23 days (IQR 11-27 days).
16.4% (141) patients developed AKI; 11.1% (96) with AKI stage 1, 3% (26) with AK1 stage 2 and 2.6% (19) with AKI stage 3.
AKI was associated with increased LoS. Death was adjusted for by assigning median LoS to those who died. Median LoS was 31 days (IQR 16-36 days) in patients with AKI compared to 22 days (IQR 11-25 days) without AKI. Patients who developed AKI were less likely to be discharged home. 31.9% patients with AKI were discharged to their own home compared with 41.7% of patients without AKI.
AKI was associated with increased unadjusted mortality. Patients with AKI had a 30 day mortality of 16.3% compared with 4.4% in patients without AKI. 30 day mortality was 15.6%, 19.2% and 15.8% in patients with AKI stage 1, 2 and 3, respectively. Patients with AKI had an inpatient mortality of 16.3% compared with 3.75% in patients without AKI. Inpatient mortality was 13.5%, 19.2% and 26.3% in patients with AKI stage 1, 2 and 3, respectively.

Conclusion

The incidence of AKI at our unit (16.4%) is significantly lower than previously published data (24%) but despite this, it is associated with increased LoS and mortality. This suggests early and intensive ortho-geriatrician and multi-disciplinary team input can improve AKI incidence and also outcomes in these patients.