Zhang J1,2, Wang Z1,2, Diwan V1,2, VENUTHURUPALLI S1,3, HEALY H1,2,4, HOY W1,2
1Faculty of Medicine, University of Queensland , Brisbane , Australia, 2NHMRC CKD.CRE and CKD.QLD, Brisbane , Australia, 3Kidney Health Service, Toowoomba Hospital, Toowoomba, Australia, 4Kidney Health Service, Royal Brisbane and Women’s Hospital, Brisbane , Australia
Aim: To characterise acute kidney injury (AKI) in two cohorts with chronic kidney disease (CKD) from different health care settings in Queensland.
Background: AKI is increasing globally, but it has limited visibility in people with preterminal CKD.
Methods: Two CKD cohorts admitted to Queensland hospitals were retrospectively followed from their first hospital admission after May 2011, until June 2018 or an earlier endpoint (death or KRT). Cohort 1 were CKD.QLD registry patients in public renal specialty practices, and Cohort 2 were admitted persons with CKD from other renal health care environments, matched 3:1 with CKD.QLD patients and stratified by regional Health Service. AKI was defined by ICD10AM codes using the AIHW definition.
Results: In Cohort 1, 3,378 of 7,341 patients (46%), mean age 67 years, had >1 AKI episode. In Cohort 2, 12,715 of 22,023 patients (57.7%), mean age 74 years, had >1 AKI episode. Among those with AKI in Cohort 1, AKI was principal diagnosis in 26.3%, and 43.6% had >3 AKI episodes. Among those with AKI in Cohort 2, AKI was principal diagnosis in 19.8%, and 37.5% had >3 episodes of AKI. In both cohorts, those with AKI as principal diagnosis had the highest numbers of admissions, emergency admissions and length of stay. Among AKI patients in Cohort 1, 10.7% started KRT, accounting for 42.9% of all KRT, and 32.3% died, constituting 67.7% of all deaths. Among AKI patients in Cohort 2, 3.4% started KRT, accounting for 35.8% of all KRT and 49.4% died, accounting for 66.2% of all deaths.
Conclusions: AKI is very common in people with CKD. It powerfully predicts poor outcomes. Prevention and mitigation are top priorities.
Dr Jenny Zhang is a Research Fellow with Centre for Chronic Disease, Faculty of Medicine of The University of Queensland. She has experience in health service research in chronic diseases with a strong background in quantitative research methodology and data analysis.