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  • Review Article
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Acute kidney injury—epidemiology, outcomes and economics

Nature Reviews Nephrology volume 10, pages 193–207 (2014)Cite this article

Subjects

Key Points

  • Acute kidney injury (AKI) occurs in an estimated one in five adults and one in three children hospitalized with acute illness; the incidence of AKI is increasing

  • Subclinical AKI, defined as elevation in levels of kidney damage biomarkers not fulfilling the conventional criteria for AKI, has characterized a subgroup of patients with increased risk of poor outcome

  • Bedside clinical information systems can enable real-time automated electronic alerting for patients at risk of AKI or who develop early AKI; these systems can be integrated with evidence-based decision support tools

  • The mortality associated with AKI remains unacceptably high, and increasing severity correlates with increasing mortality, the highest of which is among patients with overt kidney failure requiring renal replacement therapy

  • Reduced health-related quality of life and incident disability are increasingly recognized as important patient-centred outcomes following acute illness complicated by AKI

  • AKI is now recognized as an important risk factor for nonrecovery of kidney function, incident chronic kidney disease, and accelerated progression to end-stage renal disease

Abstract

Acute kidney injury (AKI) is a widespread problem of epidemic status. Compelling evidence indicates that the incidence of AKI is rapidly increasing, particularly among hospitalized patients with acute illness and those undergoing major surgery. This increase might be partially attributable to greater recognition of AKI, improved ascertainment in administrative data and greater sensitivity of consensus diagnostic and classification schemes. Other causes could be an ageing population, increasing incidences of cardiovascular disease, diabetes mellitus and chronic kidney disease (CKD), and an expanding characterization of modifiable risk factors, such as sepsis, administration of contrast media and exposure to nephrotoxins. The sequelae of AKI are severe and characterized by increased risk of short-term and long-term mortality, incident CKD and accelerated progression to end-stage renal disease. AKI-associated mortality is decreasing, but remains unacceptably high. Moreover, the absolute number of patients dying as a result of AKI is increasing as the incidence of the disorder increases, and few proven effective preventative or therapeutic interventions exist. Survivors of AKI, particularly those who remain on renal replacement therapy, often have reduced quality of life and consume substantially greater health-care resources than the general population as a result of longer hospitalizations, unplanned intensive care unit admissions and rehospitalizations.

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Figure 1: Association between the incidence and mortality for acute kidney injury when assessed by a | absolute changes in serum creatinine levels and b | changes in serum creatinine levels relative to baseline.
Figure 2: Kaplan–Meier graph for hospital survival, stratified by KDIGO stages of acute kidney injury.
Figure 3: Long-term survival stratified by CKD and AKI.

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Acknowledgements

S. M. Bagshaw holds a Canada Research Chair in Critical Care Nephrology and his research is supported by a Clinical Investigator Award from Alberta Innovates–Health Solutions.

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  1. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Clinical Sciences Building, 2–124E, 8440–112 Street North West Edmonton, T6G 2B7, AB, Canada

    Oleksa Rewa & Sean M. Bagshaw

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Both authors researched the data for the article, contributed to discussions of the content, wrote the article and reviewed and edited the manuscript before submission.

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S. M. Bagshaw has consulted for Alere Inc, Baxter Inc and Gambro Inc. O. Rewa declares no competing interests.

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Rewa, O., Bagshaw, S. Acute kidney injury—epidemiology, outcomes and economics. Nat Rev Nephrol 10, 193–207 (2014). https://doi.org/10.1038/nrneph.2013.282

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