Acute Kidney Injury Tied to Poor Outcomes in Hospitals

TOPLINE:A substantial proportion of patients admitted to hospitals in Italy experienced acute kidney injury (AKI), which was associated with worsened in-hospital mortality outcomes, longer hospital stays, and more frequent admissions to intensive care units (ICUs).

METHODOLOGY:Researchers conducted a retrospective observational study to examine the incidence of AKI in two Italian university hospitals from January 2016 to December 2019.They included 87,087 adult patients (mean age, 69.2 years; 49.9% men), excluding those with chronic kidney disease (CKD) stages 4 and 5, and collected demographic, clinical, and laboratory information from the hospital’s electronic database.The incidence of AKI was determined on the basis of changes in serum creatinine levels, calculated as the ratio of the peak to the lowest serum creatinine level during hospitalisation; AKI was graded according to the Kidney Disease: Improving Global Outcomes criteria.In the subgroup of patients with available prehospital estimated glomerular filtration rate data (n = 34,285), those with “de novo” AKI (without preexisting CKD) were compared with those who developed AKI with preexisting CKD.Outcomes of the study were incident in-hospital AKI, overall mortality, length of hospital stay, discharge type (protected vs at home), and persistence or recovery of AKI during discharge.TAKEAWAY:Overall, AKI occurred in 20.6% of patients, with stage 1 AKI accounting for around 60% of patients; those with AKI were older and showed a higher prevalence of comorbidities such as diabetes, CKD, heart failure, and sepsis.The occurrence of AKI was identified as an independent predictor of the risk for mortality (hazard ratio, 1.23; P < .0001), with mortality rates increasing with the severity of AKI (P < .001); patients with vs without AKI also had prolonged hospital stays and increased ICU admissions.Compared with patients with "de novo" AKI, those who developed AKI with preexisting CKD had significantly higher rates of mortality (P = .045) and ICU admissions (P = .02) and developed more severe renal complications during hospitalisation.Among 14,774 patients with AKI who survived hospitalisation, 17.6% showed persistent AKI at discharge, often requiring more frequent ICU admissions and longer hospitalisation.IN PRACTICE:"In these high-risk patients, establishing specialised post-AKI outpatient clinics, in collaboration with nephrologists and general practitioners, is crucial in warranting a proper follow-up. In this setting, given the advanced age of many AKI patients, incorporating telemedicine and digital health approaches could further enhance post-AKI care," the authors wrote. SOURCE:This study was led by Pasquale Esposito, University of Genova, Genova, Italy. It was published online on April 24, 2025, in Scientific Reports. LIMITATIONS:The usage of serum creatinine–based AKI definitions may have missed some cases, particularly community-acquired AKI. Clinical conditions such as sepsis and prolonged hospitalisation, especially in critical care settings, may affect serum creatinine production and its reliability as a kidney function marker. This study lacked information about AKI aetiology. DISCLOSURES:No funding information was provided for this study. The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.