Where AKI Develops Affects Death Risk

Patients are more likely to die if their AKI was acquired in the hospital rather than in the community.
Patients are more likely to die if their AKI was acquired in the hospital rather than in the community.

Hospital-acquired acute kidney injury (h-AKI) is associated with significantly greater mortality and longer hospital stays than community-acquired AKI (c-AKI), according to a new study.

Patients with hospital-acquired AKI who survive, however, are more likely to be independent of renal replacement therapy at discharge and follow-up.

In a retrospective study, Ching Ling Pang, MD, and colleagues at the Heart of England NHS Foundation Trust, U.K., analyzed data from 306 patients with AKI who received intermittent hemodialysis and had a 6-month follow-up visit. Of the 306 patients, 250 had community-acquired AKI and 56 had hospital-acquired AKI.

The survival rates at hospital discharge were significantly lower for the h-AKI group than the c-AKI group (42.9% vs. 72%), the researchers reported online ahead of print in the European Journal of Internal Medicine. The survival rates at 6 months, however, did not differ significantly (82.8% vs. 87.5%). In addition, 35% of the c-AKI group was dialysis dependent at hospital discharge compared with 16.7% of the h-AKI group.

At 6 months, 32.2% of patients in the c-AKI group were dialysis dependent at 6 months compared with 12.5% of those in the h-AKI group. The investigators hypothesize that renal survival benefit in the h-AKI group was due to a higher proportion of patients with sepsis and a pre-renal cause of AKI, so survivors had a greater chance to recover renal function.

The mean length of stay was 23.9 days for the c-AKI group compared with 48.6 days for the h-AKI group.

The investigators noted that their findings are consistent with data from other studies, where mortality associated with AKI requiring renal replacement therapy has been reported to be as high as 70%.

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