Clinical characteristics of community-acquired and hospital-acquired kidney injury

Abstract

Acute kidney injury (AKI) is increasing in global incidence and is independently associated with significant morbidity and mortality. There is limited published evidence in Australia on interventions to improve early recognition and management of AKI and on investigating the impact of early involvement of nephrologists on clinical outcomes associated with AKI. This thesis aimed to determine the incidence, current management, and consequences of AKI (hospital and community-acquired) in all patients admitted to a tertiary hospital to inform the development of a digital tool for early detection of AKI and thereby improve clinical outcomes. A literature review was conducted to identify interventional studies on electronic alerts (e-alerts) and care bundles that help increase AKI recognition and assess the impact of these interventions on clinical outcomes in patients with AKI. Two retrospective studies were performed on patients admitted to a tertiary hospital. Clinical characteristics and outcomes of these patients were analysed by receipt of nephrology consultation. Statistical analysis included descriptive, simple Chi-squared/Fischer Exact test, independent samples t-test/Mann-Whitney U test and logistic regression analysis. The literature review identified that interventions targeting AKI are varied, and that their effect on clinical efficacy is mixed and inconsistent. The clinical characteristics of patients who acquire AKI are similar from both of our studies; relatively older, multiple pre-existing comorbidities and medications, and were predominantly mild stage 1 AKI. There was no significant difference in patient outcomes on receipt of nephrology consultation. Although our results did not support improved patient outcomes on nephrology referral, larger-scale prospective studies are required to understand the impact of interventions on patient outcomes, such as hospital readmission and mortality.