Epidemiology

The reported incidences of AKI vary, and are confounded by differences in diagnosis, definition criteria, or hospital discharge coding.[6][7] In the US, the total number of hospitalizations for AKI increased from 953,926 in 2000 to 3,959,560 in 2014.[8] Among people hospitalized in 2014 with AKI, 40% also had diabetes.[8] Overall incidence of AKI among hospitalized patients ranges from 13% to 22%.[3][9] In the intensive care unit (ICU), the incidence of AKI is higher.[10] Prediction scores have been developed for outcomes of AKI, but have had variable success.[11][12]

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.[13][14]

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.[15]

Up to 7% of patients hospitalized with AKI require renal replacement therapy.[16] In the ICU, the mortality rate exceeds 50% in patients with multiorgan failure who require dialysis.[13][14][16] 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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