Epidemiology of acute kidney injury in the clinical emergency: A prospective cohort study at a high-complexity public university hospital in São Paulo, Brazil

Southern Hemisphere countries have been underrepresented in epidemiological studies on acute kidney injury (AKI). The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity t...

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Published in:PloS one 2024-09, Vol.19 (9), p.e0309949
Main Authors: Azevedo, Flávia Barros de, Samaan, Farid, Zanetta, Dirce Maria Trevisan, Yu, Luis, Velasco, Irineu Tadeu, Burdmann, Emmanuel de Almeida
Format: Article
Language:English
Subjects:
Acute Kidney Injury - epidemiology
Acute Kidney Injury - etiology
Acute renal failure
Adult
Aged
Brazil
Brazil - epidemiology
Cardiovascular diseases
Chronic kidney failure
Comorbidity
Complexity
Congestive heart failure
Creatinine
Death
Dehydration
Demographic aspects
Diabetes mellitus
Edema
Emergency medical care
Emergency medical services
Emergency Service, Hospital - statistics & numerical data
Epidemiology
Female
Health aspects
Heart diseases
Heart failure
Hospital Mortality
Hospitalization - statistics & numerical data
Hospitals
Hospitals, University
Humans
Hypertension
Hypotension
Kidney diseases
Kidneys
Liver
Liver diseases
Male
Medical research
Medicine and Health Sciences
Medicine, Experimental
Middle Aged
Mortality
Nonsteroidal anti-inflammatory drugs
Patient outcomes
Patients
Prospective Studies
Risk Factors
Southern Hemisphere
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Samaan, Farid
Zanetta, Dirce Maria Trevisan
Yu, Luis
Velasco, Irineu Tadeu
Burdmann, Emmanuel de Almeida
description Southern Hemisphere countries have been underrepresented in epidemiological studies on acute kidney injury (AKI). The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity teaching hospital in the city of São Paulo, Brazil. Observational and prospective study. AKI was defined by the KDIGO guidelines (Kidney Disease: Improving Global Outcomes) using only serum creatinine. Among the 731 patients studied (age: median 61 years, IQR 47-72 years; 55% male), 48% had hypertension and 28% had diabetes as comorbidities. The frequency of AKI was 52.1% (25.9% community-based AKI [C-AKI] and 26.3% hospital-acquired AKI [H-AKI]). Dehydration, hypotension, and edema were found in 29%, 15%, and 15% of participants, respectively, at hospital admission. The in-hospital and 12-month mortality rates of patients with vs. without AKI were 25.2% vs. 11.1% (p
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The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity teaching hospital in the city of São Paulo, Brazil. Observational and prospective study. AKI was defined by the KDIGO guidelines (Kidney Disease: Improving Global Outcomes) using only serum creatinine. Among the 731 patients studied (age: median 61 years, IQR 47-72 years; 55% male), 48% had hypertension and 28% had diabetes as comorbidities. The frequency of AKI was 52.1% (25.9% community-based AKI [C-AKI] and 26.3% hospital-acquired AKI [H-AKI]). Dehydration, hypotension, and edema were found in 29%, 15%, and 15% of participants, respectively, at hospital admission. The in-hospital and 12-month mortality rates of patients with vs. without AKI were 25.2% vs. 11.1% (p&lt;0.001) and 36.7% vs. 12.9% (p&lt;0.001), respectively. The independent risk factors for C-AKI were chronic kidney disease (CKD), chronic liver disease, age, and hospitalization for cardiovascular disease. Those for H-AKI were CKD, heart failure as comorbidities, hypotension, and edema at hospital admission. H-AKI was an independent risk factor for death in the hospital, but not at 12 months. C-AKI was not a risk factor for death. AKI occurred in more than half of the admissions to the clinical emergency department of the hospital and was equally distributed between C-AKI and H-AKI. Many patients had correctable risk factors for AKI, such as dehydration and arterial hypotension (44%) at admission. 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Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Meteorological &amp; Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agriculture Science Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest Biological Science Journals</collection><collection>Engineering Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest advanced technologies &amp; aerospace journals</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials science collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Azevedo, Flávia Barros de</au><au>Samaan, Farid</au><au>Zanetta, Dirce Maria Trevisan</au><au>Yu, Luis</au><au>Velasco, Irineu Tadeu</au><au>Burdmann, Emmanuel de Almeida</au><au>Lazzeri, Chiara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology of acute kidney injury in the clinical emergency: A prospective cohort study at a high-complexity public university hospital in São Paulo, Brazil</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2024-09-05</date><risdate>2024</risdate><volume>19</volume><issue>9</issue><spage>e0309949</spage><pages>e0309949-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Southern Hemisphere countries have been underrepresented in epidemiological studies on acute kidney injury (AKI). The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity teaching hospital in the city of São Paulo, Brazil. Observational and prospective study. AKI was defined by the KDIGO guidelines (Kidney Disease: Improving Global Outcomes) using only serum creatinine. Among the 731 patients studied (age: median 61 years, IQR 47-72 years; 55% male), 48% had hypertension and 28% had diabetes as comorbidities. The frequency of AKI was 52.1% (25.9% community-based AKI [C-AKI] and 26.3% hospital-acquired AKI [H-AKI]). Dehydration, hypotension, and edema were found in 29%, 15%, and 15% of participants, respectively, at hospital admission. The in-hospital and 12-month mortality rates of patients with vs. without AKI were 25.2% vs. 11.1% (p&lt;0.001) and 36.7% vs. 12.9% (p&lt;0.001), respectively. The independent risk factors for C-AKI were chronic kidney disease (CKD), chronic liver disease, age, and hospitalization for cardiovascular disease. Those for H-AKI were CKD, heart failure as comorbidities, hypotension, and edema at hospital admission. H-AKI was an independent risk factor for death in the hospital, but not at 12 months. C-AKI was not a risk factor for death. AKI occurred in more than half of the admissions to the clinical emergency department of the hospital and was equally distributed between C-AKI and H-AKI. Many patients had correctable risk factors for AKI, such as dehydration and arterial hypotension (44%) at admission. The only independent risk factor for both C-AKI and H-AKI was CKD as comorbidity.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>39236044</pmid><doi>10.1371/journal.pone.0309949</doi><tpages>e0309949</tpages><orcidid>https://orcid.org/0000-0003-4393-7330</orcidid><orcidid>https://orcid.org/0000-0001-9102-0063</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
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issn 1932-6203
1932-6203
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source Publicly Available Content Database; PubMed Central; Coronavirus Research Database
subjects Acute Kidney Injury - epidemiology
Acute Kidney Injury - etiology
Acute renal failure
Adult
Aged
Brazil
Brazil - epidemiology
Cardiovascular diseases
Chronic kidney failure
Comorbidity
Complexity
Congestive heart failure
Creatinine
Death
Dehydration
Demographic aspects
Diabetes mellitus
Edema
Emergency medical care
Emergency medical services
Emergency Service, Hospital - statistics & numerical data
Epidemiology
Female
Health aspects
Heart diseases
Heart failure
Hospital Mortality
Hospitalization - statistics & numerical data
Hospitals
Hospitals, University
Humans
Hypertension
Hypotension
Kidney diseases
Kidneys
Liver
Liver diseases
Male
Medical research
Medicine and Health Sciences
Medicine, Experimental
Middle Aged
Mortality
Nonsteroidal anti-inflammatory drugs
Patient outcomes
Patients
Prospective Studies
Risk Factors
Southern Hemisphere
title Epidemiology of acute kidney injury in the clinical emergency: A prospective cohort study at a high-complexity public university hospital in São Paulo, Brazil
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