The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury
Background: Acute kidney injury (AKI) is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED) setting. Objective: The objective of this study was to describe the risk factors, prevalence, management, and outcomes in t...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2017-04-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/2054358117703985 |
| _version_ | 1818497735427358720 |
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| author | Frank Xavier Scheuermeyer Eric Grafstein Brian Rowe Jay Cheyne Brian Grunau Aaron Bradford Adeera Levin |
| author_facet | Frank Xavier Scheuermeyer Eric Grafstein Brian Rowe Jay Cheyne Brian Grunau Aaron Bradford Adeera Levin |
| author_sort | Frank Xavier Scheuermeyer |
| collection | DOAJ |
| description | Background: Acute kidney injury (AKI) is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED) setting. Objective: The objective of this study was to describe the risk factors, prevalence, management, and outcomes in the ED population, and to identify the proportion of AKI patients who were discharged home with no renal-specific follow-up. Design: This is a retrospective cohort study using administrative and laboratory databases. Setting: Two urban EDs in Vancouver, British Columbia, Canada. Patients: We included all unique ED patients over a 1-week period. Methods: All patients had their described demographics, comorbidities, medications, laboratory values, and ED treatments collected. AKI was defined pragmatically, based upon accepted guidelines. The cohort was then probabilistically linked to the provincial renal database to ascertain renal replacement (transplant or dialysis) and the provincial vital statistics database to obtain mortality. The primary outcome was the prevalence of AKI; secondary outcomes included (1) the proportion of AKI patients who were discharged home with no renal-specific follow-up and (2) the combined 30-day rate of death or renal replacement among AKI patients. Results: There were 1651 ED unique patients, and 840 had at least one serum creatinine (SCr) obtained. Overall, 90 patients had AKI (10.7% of ED patients with at least one SCr, 95% confidence interval [CI], 8.7%-13.1%; 5.5% of all ED patients, 95% CI, 4.4%-6.7%) with a median age of 74 and 70% male. Of the 31 (34.4%) AKI patients discharged home, 4 (12.9%) had renal-specific follow-up arranged in the ED. Among the 90 AKI patients, 11 died and none required renal replacement at 30 days, for a combined outcome of 12.2% (95% CI, 6.5%-21.2%). Limitations: Sample sizes may be small. Nearly half of ED patients did not obtain an SCr. Many patients did not have sequential SCr testing, and a modified definition of AKI was used. |
| first_indexed | 2024-12-10T18:48:56Z |
| format | Article |
| id | doaj.art-23ce3e1c69754713846e3e93254a5aa6 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-12-10T18:48:56Z |
| publishDate | 2017-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-23ce3e1c69754713846e3e93254a5aa62022-12-22T01:37:23ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812017-04-01410.1177/205435811770398510.1177_2054358117703985The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney InjuryFrank Xavier Scheuermeyer0Eric Grafstein1Brian Rowe2Jay Cheyne3Brian Grunau4Aaron Bradford5Adeera Levin6The University of British Columbia, Vancouver, CanadaDepartment of Emergency Medicine, Mount Saint Joseph Hospital, Vancouver, British Columbia, CanadaUniversity of Alberta, Edmonton, CanadaThe University of British Columbia, Vancouver, CanadaThe University of British Columbia, Vancouver, CanadaThe University of British Columbia, Vancouver, CanadaDivision of Nephrology, Department of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, CanadaBackground: Acute kidney injury (AKI) is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED) setting. Objective: The objective of this study was to describe the risk factors, prevalence, management, and outcomes in the ED population, and to identify the proportion of AKI patients who were discharged home with no renal-specific follow-up. Design: This is a retrospective cohort study using administrative and laboratory databases. Setting: Two urban EDs in Vancouver, British Columbia, Canada. Patients: We included all unique ED patients over a 1-week period. Methods: All patients had their described demographics, comorbidities, medications, laboratory values, and ED treatments collected. AKI was defined pragmatically, based upon accepted guidelines. The cohort was then probabilistically linked to the provincial renal database to ascertain renal replacement (transplant or dialysis) and the provincial vital statistics database to obtain mortality. The primary outcome was the prevalence of AKI; secondary outcomes included (1) the proportion of AKI patients who were discharged home with no renal-specific follow-up and (2) the combined 30-day rate of death or renal replacement among AKI patients. Results: There were 1651 ED unique patients, and 840 had at least one serum creatinine (SCr) obtained. Overall, 90 patients had AKI (10.7% of ED patients with at least one SCr, 95% confidence interval [CI], 8.7%-13.1%; 5.5% of all ED patients, 95% CI, 4.4%-6.7%) with a median age of 74 and 70% male. Of the 31 (34.4%) AKI patients discharged home, 4 (12.9%) had renal-specific follow-up arranged in the ED. Among the 90 AKI patients, 11 died and none required renal replacement at 30 days, for a combined outcome of 12.2% (95% CI, 6.5%-21.2%). Limitations: Sample sizes may be small. Nearly half of ED patients did not obtain an SCr. Many patients did not have sequential SCr testing, and a modified definition of AKI was used.https://doi.org/10.1177/2054358117703985 |
| spellingShingle | Frank Xavier Scheuermeyer Eric Grafstein Brian Rowe Jay Cheyne Brian Grunau Aaron Bradford Adeera Levin The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury Canadian Journal of Kidney Health and Disease |
| title | The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury |
| title_full | The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury |
| title_fullStr | The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury |
| title_full_unstemmed | The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury |
| title_short | The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury |
| title_sort | clinical epidemiology and 30 day outcomes of emergency department patients with acute kidney injury |
| url | https://doi.org/10.1177/2054358117703985 |
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