J ZHANG1,2, WE HOY1,2, K BABOOLAL3, Z WANG1,2, A CAMERON1,2,3, HG HEALY1,3, S VENUTHURUPALLI1,3, K-S TAN3, S GOVINDARAJULU3, A ROLFE3, M MANTHA3, T TITUS3, R CHERIAN3, P-C WU3, C BANNEY3, C MUTATIRI3, K MADHAN3, D RANGANATHAN3, G KAN3, T HAN3, S HOSSAIN3, A KARK3, S COLEMAN3, B TAYLOR3, AJ MALLETT3
1NHMRC CKD.CRE and CKD.QLD , Brisbane, Australia, 2Faculty of Medicine, University Of Queensland , Brisbane, Australia, 3Queensland Health , Brisbane, Australia
Aim: We describe acute kidney injury (AKI) documented in hospital episodes in patients enrolled in the CKD.QLD registry, based in the public nephrology sector in Queensland.
Background: It is recognised that AKI contributes to, and complicates CKD and can exacerbate its progression.
Methods: Queensland Health supplied data for CKD.QLD patients on admissions to all Queensland hospitals, public and private, as well as associated costs, and deaths, from May 2011 to June 2016. We describe the frequency of AKI and associated conditions, recognised by ICD codes.
Results: Among 6,371 CKD.QLD patients, 2,200 (34.5%) had a total of 4,714 hospital encounters with an AKI diagnosis: 575 patients (12.2%) had ≥ five AKI related admissions. Those with AKI were somewhat older (68.2 vs 64.6 yr) and more often male (57.1% vs 52%), than CKD patients without AKI (p<0.001). When AKI was the principal diagnosis, the leading associated diagnoses were congestive heart failure, urinary tract infection, myocardial infarction, pneumonia and COPD with infection, gastroenteritis/colitis and sepsis. When AKI was an associated condition, the leading principal diagnoses included type 2 diabetes with nephropathy and complications, essential hypertension, CKD stages 3-5, volume depletion, and congestive heart failure. Of those with AKI, 628 (28.5%) subsequently died in the 5 year interval and 286 (13%) started renal replacement therapy, compared with 314 (9.1%) who died and 319 (9.3%) who started RRT among those who did not have AKI, p<0.001 for each.
Conclusions: AKI that comes to clinical attention is very common among these CKD patients. It is associated with strikingly increased deaths and more need for RRT. Patients who suffer AKI during the course of CKD may need closer monitoring to improve outcome.
Dr Jenny Zhang is a Research Fellow with the Centre for Chronic Disease, The University of Queensland. She is coordinating and working with colleagues and collaborators in various projects. Her roles include project design and data management, statistical analysis, reporting and manuscript writing. Dr Zhang has experience in public health research in the area of primary health care, health service utilisation, socioeconomic health inequalities, chronic disease prevention, behavioural medicine, and medical education, with a strong background in quantitative research methodology and data analysis skills.