The reported incidences of AKI vary, and are confounded by differences in diagnosis, definition criteria, or hospital discharge coding. In the US, the total number of hospitalizations for AKI increased from 953,926 in 2000 to 3,959,560 in 2014. Among people hospitalized in 2014 with AKI, 40% also had diabetes. Overall incidence of AKI among hospitalized patients ranges from 13% to 22%. In the intensive care unit (ICU), the incidence of AKI is higher. Prediction scores have been developed for outcomes of AKI, but have had variable success.
Acute tubular necrosis (ATN) accounts for 45% of cases of AKI. ATN is caused by sepsis in 19% of ICU patients. Prerenal azotemia, obstruction, glomerulonephritis, vasculitis, acute interstitial nephritis, acute on chronic kidney disease, and atheroembolic injury account for most of the remainder.
The incidence of contrast nephropathy varies, and is reported to be the third most common cause of AKI in hospitalized patients. In a study of 7500 patients undergoing percutaneous intervention for coronary artery disease, 3.3% of all patients experienced AKI, defined as a rise in serum creatinine of 0.5 mg/dL or more, and 25% of patients with a baseline creatinine of at least 2.0 mg/dL experienced AKI.
Up to 7% of patients hospitalized with AKI require renal replacement therapy. In the ICU, the mortality rate exceeds 50% in patients with multiorgan failure who require dialysis. Minor rises in creatinine (≥0.3 mg/dL) are associated with an increased risk of hospital mortality, increased risk of chronic kidney disease, and higher odds of progressing to end-stage renal failure.
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