Original Investigations: Pathogenesis and Treatment
Hospital-acquired renal insufficiency

Presented in part at the American Society of Nephrology Meeting, New Orleans, LA, October, 1996.
https://doi.org/10.1053/ajkd.2002.32766Get rights and content

Abstract

Despite myriad improvements in the care of hospitalized patients, a decline in renal function remains a common event. Renal function in 4,622 consecutive patients admitted to the medical and surgical services of an urban tertiary care hospital was followed up prospectively from the time of admission. Some degree of renal insufficiency developed in 7.2% of patients. Decreased renal perfusion, medications, surgery, and radiographic contrast media were the most common causes of hospital-acquired renal insufficiency (HARI). The overall mortality rate was 19.4% and was similar among patients for all causes of renal insufficiency, except sepsis. For patients with a greater than 3.0-mg/dL increase in serum creatinine level, the mortality rate was 37.8%. As shown by previous investigators, age and preexisting renal insufficiency were risk factors for HARI. Women and blacks had less hospital-acquired renal failure. The increasing acuity of hospital admissions has been accompanied by a greater incidence of acute renal insufficiency in patients admitted to hospitals. There is a trend toward better survival in patients with a severe deterioration in renal function. © 2002 by the National Kidney Foundation, Inc.

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Methods

Four thousand six hundred twenty-two consecutive patients admitted to the medical and surgical services of Rush Presbyterian-St Luke's Medical Center between February 29, 1996, and June 30, 1996, were followed up prospectively for the development of worsening renal function. Renal insufficiency was defined as an increase in serum creatinine level of 0.5 mg/dL for patients with a baseline serum creatinine level of 1.9 mg/dL or less, 1.0 mg/dL for patients with a baseline level of 2.0 to 4.9

Risk factors for renal insufficiency

Four thousand six hundred twenty-two patients were admitted to the medical and surgical services during the 4-month period (Table 1).

. Demographics of the Study Group

Empty CellAll Patients (n = 4,622)Patients With Renal Insufficiency (n = 332)P
Men2,102180 (8.6)
Women2,515150 (6)0.05
Age (y)
 20-3991734 (3.7)
 40-591,41780 (5.6)
60-791,763152 (8.6)
>8051755 (10.6)<0.001
Lowest creatinine (mg/dL)
 ≤1.23,232172 (5.3)
 >1.2959151 (15.7)<0.05
Ethnic group
 White2,248180 (8)
 Black1,687106 (6.3)
Hispanic35228 (8)<0.05

NOTE. Values

Discussion

The incidence of HARI varies depending on how this entity is defined by the investigator. We used criteria that allowed us to study mild degrees of renal insufficiency, rather than only those patients requiring dialysis because there is evidence that relatively small increases in serum creatinine level are associated with large increases in mortality, even after correction for comorbid conditions.1, 2, 4

Acute deterioration in renal function occurred in 7.2% of the 4,622 patients admitted to the

Acknowledgements

The authors thank Kimberly Traylor-Dixon for help in manuscript preparation.

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Address reprint requests to Susan Hou, MD, Renal Section, Bldg 102, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153. E-mail: [email protected]

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