Analysis On The Incidence And The Influence Factors Of Acute Kidney Injury In Hospitalized Patients

Background and purpose Acute kidney injury(AKI)is a clinical syndrome characterized by a sharp decrease in renal function within a short period of time.Research showed that about 13.3 million hospitalized patients in the world suffered from AKI every year,and the incidence of AKI was about 20%.The mortality rate of severe patients was up to 50%.In addition,the final outcomes of some AKI patients turned into chronic kidney disease,or even developed into end-stage renal disease and kept accepting long-term renal replacement therapy.It consumed a lot of medical resources and became the burden of family and social economic development.In 2013,the International Society of Nephrology(ISN)proposed 0by25 initiative for AKI,aiming that by improving the diagnosis and treatment work of AKI worldwide,there would be zero preventable deaths of AKI by 2025.Previous studies had shown that the occurrence of AKI was associated with renal hypo perfusion,sepsis,contrast agents,etc.In order to figure out the epidemiology of AKI in the First Affiliated Hospital of Anhui Medical University,and analyze the influence factors of AKI,at the same time,find and propose reasonable solutions of problems existed in the diagnosis and treatment work,the study was conducted.It can also help build the clinical database of AKI patients in Anhui province,and support the 0by25 initiative,and finally reduce the burden of the national economy.Methods A retrospective cross-sectional study was conducted in adult hospitalized patients with AKI at the First Affiliated Hospital of Anhui Medical University in January 2017 and July 2017.By using the clinical information system,adult hospitalized patients during the period who had been tested for serum creatinine at least twice were selected.According to inclusion and exclusion criteria,eligible patients with and without AKI were chosen.The electronic medical record was referred to and the incidence,basic information,chronic diseases,risk factors,diagnosis,treatment and final outcomes of the disease were recorded and statistically analyzed.Results 1.The incidence of AKI in January 2017 and July 2017 in our hospital under the diagnostic criteria of KDIGO was 0.48% and under the extended diagnostic criteria was 1.54%.The in-hospital mortality rate was 3.65%.2.The ratio of male to female AKI patients was 1.59:1,and the median age of AKI patients was 62.00(49.00,71.00)years old.Advanced age(over 60 years old)was different between the AKI group and the non-AKI group(P <0.05).3.The hospital-acquired AKI took 39.78% of the hospitalized AKI patients,and the community-acquired AKI took 60.22%.The patients from the internal medicine department and the surgery department respectively accounted for 48.91% and 43.07%.The cardiovascular disease,central nervous system disease and digestive system disease accounted for the top three reasons for patients’ hospitalization.The median time of hospitalization was 13.00(9.00,17.00)days,and the median hospitalization cost was 15977.00(11468.00,32738.00)RMB in the AKI group.The time of hospitalization and the total hospitalization cost in the AKI group were both higher than in the non-AKI group(P< 0.01).The independent risk factors of ICU treatment in patients with AKI were shock,DIC and cardiac surgery.4.The top three of the most common chronic diseases of the AKI patients were anemia,hypertension and chronic cardiovascular disease.Respiratory infection was different between the AKI group and the non-AKI group(P <0.05).5.The risk factors of AKI in hospitalized patients included advanced age(over 60 years old),respiratory infection,needing ICU treatment,diuretics and NSAIDS.The independent risk factors of AKI were respiratory infection,needing ICU treatment and NSAIDS.The main causes of hospitalized patients developing AKI were pre-renal diseases,accounting for 87.59%.6.Only 14.60% of the patients with AKI were clearly diagnosed during the hospitalization,and 60% of these patients had a diagnosis delay,with a median time of 3.00 days.Compared with KDIGO diagnostic criteria,patients diagnosed by extended diagnostic criteria had a lower risk of ICU treatment.The serum creatinine tested in the beginning of hospitalization and the peak during hospitalization affected the recognition of AKI.The severity of AKI was correlated with age,whether or not the AKI was diagnosed,craniotomy,and needing ICU treatment.7.Except for the urology department and nephrology department,only 6.40% of patients with serum creatinine changes were consulted from the nephrology department doctors,and 1.46% patients underwent renal biopsy,and 6.2% patients had indications of renal replacement therapy and underwent dialysis treatment.8.The age and the severity of AKI were the independent risk factors of short-term prognosis of patients with AKI.Conclusions 1.The estimated incidence of AKI in adult hospitalized patients in our hospital is 0.48% under the KDIGO diagnostic criteria and 1.54% under the extended diagnostic criteria.2.The independent risk factors of AKI are respiratory infection,ICU treatment,and NSAIDS.3.Paying attention to the serum creatinine in the beginning of hospitalization and the peak will contribute to identifying and diagnosing AKI.4.Focusing on elderly patients and controlling renal function lose in time can help to improve the short-term prognosis of AKI patients.