Department of Nephrology and Medical Intensive Care Medicine, Charité-Universitätsmedizin Berlin and Berlin Institute of Health, Berlin; Business Division IT, Department of Research and Teaching, Charité-Universitätsmedizin Berlin, Berlin; Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin and Berlin Institute of Health, Berlin; Biostatistics, Clinical Research Unit, Berlin Institute of Health, Berlin; Administrative Office for Digital Transformation, Charité - -Universitätsmedizin Berlin, Berlin.
Dtsch Arztebl Int. 2019 May 31;116(22):397-404. doi: 10.3238/arztebl.2019.0397.
Studies from multiple countries have shown that acute kidney injury (AKI) in hospitalized patients is associated with mortality and morbidity. There are no reliable data at present on the incidence and mortality of AKI episodes among hospitalized patients in Germany. The utility of administrative codings of AKI for the identification of AKI episodes is also unclear.
In an exploratory approach, we retrospectively analyzed all episodes of AKI over a period of 3.5 years (2014-2017) on the basis of routinely obtained serum creatinine measurements in 103 161 patients whose creatinine had been measured at least twice and who had been in the hospital for at least two days. We used the "Kidney Disease: Improving Global Outcomes" (KDIGO) criteria for AKI. In parallel, we assessed the administrative coding of discharge diagnoses of the same patients with codes from the International Classification of Diseases (ICD-10-GM).
Among 185 760 hospitalizations, stage 1 AKI occurred in 25 417 cases (13.7%), stage 2 in 8503 cases (4.6%), and stage 3 in 5881 cases (3.1%). AKI cases were associated with length of hospital stay, renal morbidity, and overall mortality, and this association was stage-dependent. The in-hospital mortality was 5.1% for patients with stage 1 AKI, 13.7% for patients with stage 2 AKI, and 24.8% for patients with stage 3 AKI. An administrative coding for acute kidney injury (N17) was present in only 28.8% (11 481) of the AKI cases that were identified by creatinine criteria. Like the AKI cases overall, those that were identified by creatinine criteria but were not coded as AKI had significantly higher mortality, and this association was stage-dependent.
AKI episodes are common among hospitalized patients and are associated with considerable morbidity and mortality, yet they are inadequately documented and probably often escape the attention of the treating physicians.
来自多个国家的研究表明，住院患者的急性肾损伤（AKI）与死亡率和发病率有关。目前，德国住院患者 AKI 发作的发生率和死亡率尚无可靠数据。行政编码 AKI 用于识别 AKI 发作的实用性也不清楚。
我们采用探索性方法，根据至少两次测量血清肌酐且住院时间至少两天的 103161 名患者的常规获得的血清肌酐测量值，回顾性分析了 3.5 年（2014-2017 年）期间的所有 AKI 发作。我们使用“肾脏病：改善全球结局”（KDIGO）AKI 标准。同时，我们评估了相同患者的出院诊断的行政编码，使用疾病国际分类（ICD-10-GM）的代码。
在 185760 例住院治疗中，1 期 AKI 发生在 25417 例（13.7%），2 期 AKI 发生在 8503 例（4.6%），3 期 AKI 发生在 5881 例（3.1%）。AKI 病例与住院时间、肾脏发病率和总体死亡率相关，且这种关联与分期有关。1 期 AKI 患者的院内死亡率为 5.1%，2 期 AKI 患者的死亡率为 13.7%，3 期 AKI 患者的死亡率为 24.8%。仅 28.8%（11481 例）通过肌酐标准确定的 AKI 病例存在急性肾损伤（N17）的行政编码。与整体 AKI 病例一样，通过肌酐标准确定但未编码为 AKI 的病例的死亡率明显更高，且这种关联与分期有关。
AKI 发作在住院患者中很常见，与相当大的发病率和死亡率有关，但记录不足，可能经常被治疗医生忽视。
