The reported incidences of AKI vary, and are confounded by differences in diagnosis, definition criteria, or hospital discharge coding. The rate of hospitalizations for AKI in US Medicare patients increased by approximately 35% between 2010 and 2019. Patients with diabetes were hospitalized with AKI at a greater than 2-fold higher rate compared with those without diabetes, and patients with chronic kidney disease (CKD) and diabetes were hospitalized with AKI at a more than 7.5-fold higher rate compared to patients with neither pre-existing condition. 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 in terms of reproducibility or utility.
Acute tubular necrosis (ATN) accounts for 45% of cases of AKI. ATN is caused by sepsis in approximately 20% 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. One large systematic review and meta-analysis reported a 9% incidence of contrast-induced nephropathy in patients undergoing angiography for any reason, including percutaneous intervention for coronary artery disease, with 0.5% of patients requiring dialysis.
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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