A BENDALL 1, S TAN 1,2, E SEE 2,3, T FAZIO 2,4, N TOUSSAINT 1,2
1Department of Nephrology, Royal Melbourne Hospital , Melbourne, Parkvile, Australia , 2Department of Medicine, University of Melbourne, Melbourne, Parkvile , Australia, 3Department of Intensive Care, Austin Health , Melbourne, Heidelberg , Australia , 4Business Intelligence Unit, Royal Melbourne Hospital , Melbourne, Parkville, Australia
Aim: To quantify the incidence and outcome of community- (CA-AKI) and hospital-acquired acute kidney injury (HA-AKI) in a large metropolitan quaternary-referral hospital.
Background: The global incidence of AKI is rising. The paucity of contemporary Australian data on AKI incidence and outcome means the local burden of disease is uncertain.
Methods: A retrospective observational study of adult patients admitted between 1 January 2018 and 31 December 2019 was performed. All admissions >24-hrs with more than one serum creatinine recorded were included. Patients on maintenance dialysis were excluded. Baseline characteristics, length of stay (LoS), discharge destination and 30-day mortality were analysed between groups using one-way ANOVA, Kruskal-Wallis test or chi-square test.
Results: 6477 AKI episodes were recorded in 24-months (incidence 14.8%). HA-AKI accounted for 55.9% of AKI episodes. Most AKI episodes (77%, n=5011) were KDIGO stage 1, while 8% (n=519) were stage 3. Patients with AKI were older (mean age for CA-AKI, HA-AKI and no AKI – 65, 69, and 62 years respectively [p<0.001]), more comorbid, and more likely to have a history of chronic kidney disease (CKD). Median LoS was longer for both CA-AKI (8.8 days) and HA-AKI (11.8 days), compared to no AKI (4.9 days) (p=<0.001). Higher rates of 30-day mortality were observed in those with HA-AKI (12.82%) and CA-AKI (10.15%), compared to no AKI (3.71%), p<0.001.
Conclusions: This study demonstrated a contemporary incidence of AKI in Australia that exceeds previous reports. Patients who experienced AKI were older with more co-morbidities, and CKD was a significant risk factor. The increase in LoS and 30-day mortality for patients with AKI highlights the importance of developing hospital-wide initiatives to target this common complication.
Currently completing second year nephrology advanced training. My first year of training was completed at the Royal Melbourne Hospital and presently working at Eastern Health. Interested broadly in general nephrology, acute kidney injury and glomerular diseases.