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Abstract: TH-PO005

Comparison of Community and In-Hospital Acquired AKI in the Clinical Emergency Department at a University Tertiary Hospital

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Marçal, Lia Junqueira, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Azevedo, Flávia Barros, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Torres, Veronica, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • de Souza, Graziela Ramos barbosa de, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Antonangelo, Leila, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Zanetta, Dirce M T, University of São Paulo, S Paulo, Brazil
  • Yu, Luis, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
Background

Prospective studies comparing frequency and outcomes of community and in-hospital (IH) acquired acute kidney injury (AKI) in patients (pts) admitted to the Emergency Department (ED) are scarce, especially in developing countries.

Methods

This study aimed to compare the frequency, characteristics and outcomes of community AKI (CAKI) vs. IH acquired AKI diagnosed by RIFLE or/and KDIGO (serum creatinine criteria - SCr) in pts admitted to the ED through a referred emergency room (ER) of a tertiary university hospital. All pts ≥ 18 years old hospitalized in the ED were included. Exclusion criteria: decline to sign the informed consent, IH < 48 h, chronic kidney disease stage 5, pts on palliative care and renal transplant. Pts were assessed until the hospitalization day 7 or discharge. SCr(mg/dl) was assessed at admission and daily or every 48h. Pts were divided in the following groups: non-AKI, community-acquired AKI (CAKI), AKI by RIFLE (ARIFLE), AKI by KDIGO (AKDIGO) and ARIFLE negative AKDIGO positive (K+R-). The assessed outcomes were length of IH stay (LoS, d), and IH mortality. Data are presented as median (minimum-maximum values) or percent (%). Statistical significance is set at p<0.05.

Results

A total of 788 pts were included, mean age 63 y (18-98y), 55.1% were male, LoS was 8d (2-132) and IH mortality was 16.7%. A total of 231 pts (29.3%) developed IH AKDIGO – mostly KDIGO I (69.7%) and 167 pts (13.6%) presented CAKI, resulting in 398 AKI pts (50.5%) Causes of hospitalization were pulmonary (36.2%), cardiovascular (11.3%), gastric (16.3%) and others (36,2%).
Major outcomes among AKI groups and Non-AKI group (IMAGE1):

Conclusion

The frequency of AKI at reference ER admission and IH acquired in the first 7d of hospitalization was strikingly high in the clinical ED. CAKI showed high frequency and mortality. KDIGO criteria diagnosed more pts than RIFLE criteria IH pts. IH mortality of AKI pts was significantly higher than non-AKI pts at the ED.

Funding

  • Government Support - Non-U.S.