• Am. J. Nephrol. · Jan 2015

    Multicenter Study Observational Study

    Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study.

    • Nattachai Srisawat, Florentina E Sileanu, Raghavan Murugan, Rinaldo Bellomod, Paolo Calzavacca, Rodrigo Cartin-Ceba, Dinna Cruz, Judith Finn, Eric E J Hoste, Kianoush Kashani, Claudio Ronco, Steve Webb, John A Kellum, and Acute Kidney Injury-6 Study Group.
    • The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA.
    • Am. J. Nephrol. 2015 Jan 1;41(1):81-8.

    BackgroundDespite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers.MethodsIn this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality.ResultsOf the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers.ConclusionsIn this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.© 2015 S. Karger AG, Basel.

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