Differences in community, hospital and intensive care unit-acquired acute kidney injury: observational study in a nephrology service of a developing country

Background: Acute kidney in- jury (AKI) complicates more than 7% of all in-hospital patients. The aim of this study is to investigate the differences in community, hospital and intensive care unit-acquired AKI in patients undergoing nephrology con- sultation in a tertiary hospital in a developing country. Methods: An observational cohort study of all patients with AKI admitted to the General Hospital of Fortaleza, Brazil was conducted. RIFLE criteria were used to clas- sify the patients and to assess their associa- tion with death. Univariate and multivariate analyses were performed to investigate the factors associated with death. Results: Of 491 AKI patients undergoing nephrology consul- tation, the mean age was 55.2 ± 22.9 years. Community-acquired AKI was observed in 55% of cases, general ward-acquired in 29% and ICU-acquired in 15.3%. Late Nephrol- ogy consultation was observed, and the great majority of patients had "Failure" classifi- cation (90%) according to RIFLE criteria. Intermittent hemodialysis was required in 68% of cases. The overall in-hospital mor- tality was 23%. The in-hospital mortality was higher in ICU-acquired AKI (33.6%). Community-acquired AKI had a higher mortality than general ward-acquired AKI (23% vs. 11.6%, p = 0.001). Risk factors for death were infection (OR = 2.0, p = 0.003), neoplasms (OR = 1.89, p = 0.042), commu- nity acquired-AKI (OR = 1.27, p = 0.003), ICU acquired-AKI (OR = 2.76, p < 0.0001) and need for renal replacement therapy (OR = 2.64, p < 0.001). Conclusions: AKI is a frequent and frequently fatal condition. Mortality was higher in community and ICU-acquired than hospital ward-acquired AKI.