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Original Report: Laboratory Investigation

Variation in Risk and Mortality of Acute Kidney Injury in Critically Ill Patients: A Multicenter Study

Srisawat N.a, b · Sileanu F.E.a, c · Murugan R.a · Bellomo R.d · Calzavacca P.d · Cartin-Ceba R.e · Cruz D.f · Finn J.g · Hoste E.A.h · Kashani K.e · Ronco C.i · Webb S.j · Kellum J.A.a · on behalf of the Acute Kidney Injury-6 Study Group

Author affiliations

aThe Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA; bExcellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; cDepartment of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa., USA; dDepartment of Intensive Care and Department of Medicine, Austin Hospital and University of Melbourne, Melbourne, Australia; eDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn., fDivision of Nephrology-Hypertension, University of California, San Diego, Calif., USA; gPrehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Perth, Australia; hDepartment of Intensive Care Medicine, University Hospital, Ghent University, Ghent, and Research Foundation-Flanders, Brussels, Belgium; iInternational Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy; jIntensive Care Unit, Royal Perth Hospital, Wellington Street, Perth, Australia

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Am J Nephrol 2015;41:81-88

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Article / Publication Details

First-Page Preview
Abstract of Original Report: Laboratory Investigation

Received: October 16, 2014
Accepted: December 22, 2014
Published online: February 10, 2015
Issue release date: February 2015

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

Abstract

Background: Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers. Methods: In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality. Results: Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers. Conclusions: In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.

© 2015 S. Karger AG, Basel


References

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  2. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup: Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-R212.
  3. Srisawat N, Hoste EE, Kellum JA: Modern classification of acute kidney injury. Blood Purif 2010;29:300-307.
  4. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int 2012;2:1-138.
  5. Bagshaw SM, George C, Bellomo R; ANZICS Database Management Committe: A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569-1574.
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  8. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10:R73.
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    External Resources
  13. Závada J, Hoste E, Cartin-Ceba R, Calzavacca P, Gajic O, Clermont G, Bellomo R, Kellum JA; AKI6 investigators: A comparison of three methods to estimate baseline creatinine for RIFLE classification. Nephrol Dial Transplant 2010;25:3911-3918.
  14. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, Madsen KR, Møller MH, Elkjær JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Søe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjældgaard AL, Fabritius ML, Mondrup F, Pott FC, Møller TP, Winkel P, Wetterslev J; 6S Trial Group; Scandinavian Critical Care Trials Group: Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med 2012;367:124-134.
  15. Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArthur C, McGuinness S, Rajbhandari D, Taylor CB, Webb SA; CHEST Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group: Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012;367:1901-1911.

Article / Publication Details

First-Page Preview
Abstract of Original Report: Laboratory Investigation

Received: October 16, 2014
Accepted: December 22, 2014
Published online: February 10, 2015
Issue release date: February 2015

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN


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