• Yafang Wang, Jinwei Wang, Tao Su, Zhen Qu, Minghui Zhao, Li Yang, and ISN AKF 0by25 China Consortium.
• Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
• Am. J. Kidney Dis. 2017 May 1; 69 (5): 647-657.

BackgroundThis study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI.Study DesignCross-sectional and retrospective study.Setting & ParticipantsA national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission.PredictorsThe rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted.OutcomesAll-cause in-hospital mortality and recovery of kidney function at hospital discharge.Results4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor.LimitationsPossible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine.ConclusionsThe features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources.Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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