Comparison of Hospital-Acquired and Community-Acquired Acute Kidney Injury in Hospitalized Patients

Abstract

Introduction: Little is known about patients sustaining Acute Kidney Injury (AKI) in the Community Acquired Acute Kidney Injury (CA-AKI) and how this differs from AKI in Hospital Acquired Acute Kidney Injury (HA-AKI). The objective of this study is to compare epidemiology,
clinical characteristics, etiologies, severity and outcomes of patients of these two categories.
Methods: A prospective study was conducted during seven months from September 2012 to
March 2013 in Hassan II University Hospital including all patients admitted to different departments of the hospital and having AKI. AKI was verified by applying the Acute Kidney Injury
Network (AKIN) criteria, and patients were categorized as CA-AKI if AKIN criteria were met
at admission. While HA-AKI was defined as if AKIN criteria were met twenty-four hours or
longer after hospitalization.
Results: Among the 210 patients with AKI, 157 were classified as CA-AKI (74.8%). There
was no significant difference in age average and comorbidities between CA-AKI and HA-AKI.
Dehydration and volume depletion were significantly more prevalent in patients with CA-AKI
(47.7% vs. 34% for HA-AKI p<0.04). While HA-AKI was associated with a significantly higher prevalence of acute tubular necrosis than CA-AKI (50% vs. 3,8% in CA-AKI p<0.0001).
Having the same severity of AKI, the two groups had sustained a high rate of residual renal failure. Also there were no significant differences between the numbers of patients requiring renal
replacement therapy, and the length of hospital stay in both groups. The mortality in hospital
was significantly higher in the HA-AKI group compared to AC-AKI group (39.6% AH-AKI
versus 25.4% AC-AKI p<0.03).
Conclusion: This study highlights that risk factors for CA-AKI and HA-AKI are similar, with
CA-AKI also being similar in patients with preexisting CKD, diabetes, heart disease, hypertension, and cancer. This highlights the clinical characteristics of people in the community
who may benefit from more frequent blood tests in the event of an acute illness or medication
change.