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Epidemiology of emergency department acute kidney injury

Foxwell, David A, Pradhan, Sara, Zouwail, Soha, Rainer, Timothy H and Phillips, Aled O 2020. Epidemiology of emergency department acute kidney injury. Nephrology 25 (6) , pp. 457-466. 10.1111/nep.13672

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Aim The epidemiology of Acute Kidney Injury (AKI) diagnosed in the Emergency Department (ED) is poorly described. This study describes the incidence, demographics and outcomes of patients diagnosed with AKI in the ED (ED‐AKI). Methods A prospective cohort study was completed in a University Teaching Hospital, (UK) between April and August 2016. In total 20,421 adult patients attended the ED and had a serum creatinine measurement. The incident ED‐AKI patient episodes were compared to a randomly selected cohort of non‐AKI ED patients. Results 572 patients had confirmed eAlert ED‐AKI (548 incident cases), incidence 2.8% (of all ED attendances). ED‐AKI was associated with a 24.4% in‐patient mortality (non‐AKI 3.2%, p<0.001) of which 22.3% of deaths occurred within 24‐hours and 58% within 7‐days. Progression of the admission AKI stage to a higher AKI stage was associated with a 38.8% mortality compared to a 21.4% mortality in those who did not progress (p<0.001). In multivariate analysis ED‐AKI was an independent risk for mortality (HR, 6.293; 95% CI, 1.887 to 20.790, p=0.003). For those discharged from hospital 20.4% of ED‐AKI patients re‐attend for acute assessment within 30‐days post discharge (non‐AKI 7.6%, p<0.001). At 90‐days post discharge 10.0% of ED‐AKI patients died (non‐AKI 1.4%, p<0.001). 12‐months post discharge 17.8% of ED‐AKI patients developed CKD progression or de‐novo CKD (non‐AKI 6.0%). Conclusion ED‐AKI is an independent predictor of death. Mortality is predominantly in the early stages of hospital admission, but for those who survive to discharge have significant long‐term morbidity and mortality.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Wiley
ISSN: 1320-5358
Date of First Compliant Deposit: 6 November 2019
Date of Acceptance: 13 October 2019
Last Modified: 27 Nov 2020 03:12

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