Acute kidney injury in China: a cross-sectional survey

Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. We launched a nationwide, cross-sectional survey of a...

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Published in:	The Lancet (British edition) Vol. 386; no. 10002; pp. 1465 - 1471
Main Authors:	Yang, Li, Xing, Guolan, Wang, Li, Wu, Yonggui, Li, Suhua, Xu, Gang, He, Qiang, Chen, Jianghua, Chen, Menghua, Liu, Xiaohua, Zhu, Zaizhi, Yang, Lin, Lian, Xiyan, Ding, Feng, Li, Yun, Wang, Huamin, Wang, Jianqin, Wang, Rong, Mei, Changlin, Xu, Jixian, Li, Rongshan, Cao, Juan, Zhang, Liang, Wang, Yan, Xu, Jinhua, Bao, Beiyan, Liu, Bicheng, Chen, Hongyu, Li, Shaomei, Zha, Yan, Luo, Qiong, Chen, Dongcheng, Shen, Yulan, Liao, Yunhua, Zhang, Zhengrong, Wang, Xianqiu, Zhang, Kun, Liu, Luojin, Mao, Peiju, Guo, Chunxiang, Li, Jiangang, Wang, Zhenfu, Bai, Shoujun, Shi, Shuangjie, Wang, Yafang, Wang, Jinwei, Liu, Zhangsuo, Wang, Fang, Huang, Dandan, Wang, Shun, Ge, Shuwang, Shen, Quanquan, Zhang, Ping, Wu, Lihua, Pan, Miao, Zou, Xiting, Zhu, Ping, Zhao, Jintao, Zhou, Minjie, Hu, Wenping, Wang, Jing, Liu, Bing, Zhang, Tong, Han, Jianxin, Wen, Tao, Zhao, Minghui, Wang, Haiyan
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 10.10.2015 Elsevier Limited
Subjects:	Acute Kidney Injury - diagnosis Acute Kidney Injury - epidemiology Acute Kidney Injury - therapy Adolescent Adult Age Distribution Aged Aged, 80 and over China - epidemiology Cost of Illness Cross-Sectional Studies Delayed Diagnosis - statistics & numerical data Family planning Female Hospital Mortality Hospitalization - statistics & numerical data Hospitals Humans Internal Medicine Kidney diseases Kidneys Male Medical diagnosis Medical treatment Middle Aged Mortality Nephrology Public health Risk factors Sex Distribution Young Adult China
ISSN:	0140-6736, 1474-547X
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Abstract	Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics. Of 2 223 230 patients admitted to the 44 hospitals screened in 2013, 154 950 (7·0%) were suspected of having AKI by electronic screening, of whom 26 086 patients (from 374 286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374 286) by KDIGO criteria and 2·03% (7604 of 374 286) by expanded criteria, from which we estimate that 1·4–2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI. National 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee.
AbstractList	Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics. Of 2,223,230 patients admitted to the 44 hospitals screened in 2013, 154,950 (7·0%) were suspected of having AKI by electronic screening, of whom 26,086 patients (from 374,286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374,286) by KDIGO criteria and 2·03% (7604 of 374,286) by expanded criteria, from which we estimate that 1·4-2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI. National 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee. BACKGROUNDAcute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China.METHODSWe launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics.FINDINGSOf 2,223,230 patients admitted to the 44 hospitals screened in 2013, 154,950 (7·0%) were suspected of having AKI by electronic screening, of whom 26,086 patients (from 374,286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374,286) by KDIGO criteria and 2·03% (7604 of 374,286) by expanded criteria, from which we estimate that 1·4-2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortalityINTERPRETATIONAKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI.FUNDINGNational 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee. Summary Background Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. Methods We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics. Findings Of 2 223 230 patients admitted to the 44 hospitals screened in 2013, 154 950 (7·0%) were suspected of having AKI by electronic screening, of whom 26 086 patients (from 374 286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374 286) by KDIGO criteria and 2·03% (7604 of 374 286) by expanded criteria, from which we estimate that 1·4–2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality Interpretation AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI. Funding National 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee. Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China. Methods We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics. Findings Of 2 223 230 patients admitted to the 44 hospitals screened in 2013, 154 950 (7·0%) were suspected of having AKI by electronic screening, of whom 26 086 patients (from 374 286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0·99% (3687 of 374 286) by KDIGO criteria and 2·03% (7604 of 374 286) by expanded criteria, from which we estimate that 1·4-2·9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74·2% (5608 of 7555 with available data). Renal referral was done in 21·4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59·3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality Interpretation AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI. Funding National 985 Project of China, National Natural Science Foundation of China, Beijing Training Program for Talents, International Society of Nephrology Research Committee, and Bethune Fund Management Committee.
Author	Wang, Huamin Liu, Zhangsuo Wang, Li Wang, Xianqiu Pan, Miao Wang, Jianqin Bai, Shoujun Yang, Li Li, Shaomei Liao, Yunhua Xu, Jixian Wang, Zhenfu Wang, Yafang Zhu, Zaizhi Liu, Bing Mei, Changlin Hu, Wenping He, Qiang Ding, Feng Zou, Xiting Luo, Qiong Lian, Xiyan Xu, Gang Shi, Shuangjie Li, Suhua Li, Rongshan Li, Jiangang Cao, Juan Zhao, Minghui Chen, Dongcheng Wu, Lihua Chen, Menghua Wen, Tao Chen, Jianghua Li, Yun Liu, Bicheng Shen, Yulan Liu, Luojin Wang, Yan Han, Jianxin Huang, Dandan Zhao, Jintao Zhang, Tong Mao, Peiju Zhang, Ping Wu, Yonggui Zhang, Liang Wang, Shun Ge, Shuwang Wang, Rong Zhang, Zhengrong Xing, Guolan Wang, Fang Zhou, Minjie Zha, Yan Zhu, Ping Wang, Jing Chen, Hongyu Guo, Chunxiang Wang, Haiyan Yang, Lin Xu, Jinhua Bao, Beiyan Liu, Xiaohua Wang, Jinwei Shen, Quanquan Zhang, Kun
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Snippet	Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to... Summary Background Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in... BACKGROUNDAcute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We...
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SubjectTerms	Acute Kidney Injury - diagnosis Acute Kidney Injury - epidemiology Acute Kidney Injury - therapy Adolescent Adult Age Distribution Aged Aged, 80 and over China - epidemiology Cost of Illness Cross-Sectional Studies Delayed Diagnosis - statistics & numerical data Family planning Female Hospital Mortality Hospitalization - statistics & numerical data Hospitals Humans Internal Medicine Kidney diseases Kidneys Male Medical diagnosis Medical treatment Middle Aged Mortality Nephrology Public health Risk factors Sex Distribution Young Adult
Title	Acute kidney injury in China: a cross-sectional survey
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