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Kidney Week

Abstract: TH-PO003

Epidemiology of Emergency Department AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Foxwell, David A., Cardiff University School of Medicine, Cardiff, United Kingdom
  • Pradhan, Sara, Cardiff University School of Medicine, Cardiff, United Kingdom
  • Zouwail, Soha, University Hospital of Wales, Cardiff, United Kingdom
  • Rainer, Timothy Hudson, Cardiff University School of Medicine, Cardiff, United Kingdom
  • Phillips, Aled O., Cardiff University School of Medicine, Cardiff, United Kingdom
Background

The epidemiology of Acute Kidney Injury (AKI) diagnosed in the Emergency Department (ED) is poorly described. This study describes the incidence, demographics and outcomes of patients diagnosed with AKI in the ED (ED-AKI).

Methods

Between April and August 2016 20,421 adult patients attended the ED of a University Teaching Hospital (UK) and had a serum creatinine measurement. Using an electronic AKI reporting system, 548 incident ED-AKI patients were identified and compared to a randomly selected cohort of non-AKI ED patients (n=571). Admission, short term and 12-month follow-up data was collated and compared.

Results

572 patients had a confirmed eAlert AKI (548 incident cases), giving an incidence of ED-AKI of 2.8%. ED-AKI was associated with a 24.4% inpatient mortality of which 22.3% of deaths occurred in the first 24-hours and 58% within 7 days. Progression of admission AKI stage to a higher AKI stage was associated with a 38.8% mortality compared to a 21.4% mortality in those who did not progress (p<0.001). In multivariate analysis ED-AKI was an independent risk factor for mortality (HR, 6.293; 95% CI, 1.887 to 20.790, p=0.003). For those discharged from hospital 20.4% of ED-AKI patients were re-admitted within 30-days (non-AKI 7.6%, p<0.001). At 90-days following hospital discharge 10.0% of the discharged ED-AKI group died (non-AKI discharged 90-day mortality 1.4%, p<0.001). 12-months post discharge 17.8% of ED-AKI group developed CKD progression or de-novo CKD compared to 6.0% in the non-AKI cohort.

Conclusion

AKI diagnosed in the ED is a strong independent predictor of death. ED-AKI mortality is predominantly in the first days following presentation, but for those surviving to discharge there is significant long-term morbidity and mortality