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Risk prediction for acute kidney injury in acute medical admissions in the UK

Lookup NU author(s): Dr Suren Kanagasundaram

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Abstract

Background: Acute Kidney Injury (AKI) is associated with adverse outcomes; therefore identifying patients who are at risk of developing AKI in hospital may lead to targeted prevention.Aim: We undertook a UK-wide study in acute medical units (AMUs) to define those who develop hospital-acquired AKI(hAKI); to determine risk factors associated with hAKI and to assess the feasibility of developing a risk prediction score.Design: Prospective multi-centre cohort study across 72 AMUs in the UK.Methods: Data collected from all patients who presented over a 24-h period. Chronic dialysis, community-acquiredAKI (cAKI) and those with fewer than two creatinine measurements were excluded. Primary outcome was thedevelopment of h-AKI.Results: Two thousand four hundred and fourty-six individuals were admitted to the seventy-two participating centres. Three hundred and eighty-four patients (16%) sustained AKI of whom two hundred and eighty-seven (75%) were cAKI and ninety-seven (25%) were hAKI. After exclusions, chronic kidney disease [Odds Ratio (OR) 3.08, 95% Confidence Interval (CI) 1.96–4.83], diuretic prescription (OR 2.33, 95% CI 1.5–3.65), a lower haemoglobin concentration and elevated serum bilirubin were independently associated with development of hAKI. Multi-variable model discrimination was only moderate (c-statistic 0.75).Conclusions: AKI in AMUs is common and associated with worse outcomes, with the majority of cases communityacquired. Only a small proportion of patients develop hAKI. Prognostic risk factor modelling demonstrated only moderatediscrimination implying that widespread adoption of such an AKI clinical risk score across all AMU admissions is not currently justified. More targeted risk assessment or automated methods of calculating individual risk may be more appropriate alternatives.


Publication metadata

Author(s): The RISK Investigators

Publication type: Article

Publication status: Published

Journal: QJM: An International Journal of Medicine

Year: 2019

Volume: 112

Issue: 3

Pages: 197-205

Print publication date: 01/03/2019

Online publication date: 28/11/2018

Acceptance date: 02/11/2018

ISSN (print): 1460-2725

ISSN (electronic): 1460-2393

Publisher: Oxford University Press

URL: https://doi.org/10.1093/qjmed/hcy277

DOI: 10.1093/qjmed/hcy277


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