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.
[1]Peking Univ, Hosp 1, Beijing 100034, Peoples R China.
[2]Zhengzhou Univ, Affiliated Hosp 1, Zhengzhou 450052, Peoples R China.
[3]Sichuan Prov Peoples Hosp, Chengdu, Peoples R China.
[4]Anhui Med Univ, Affiliated Hosp 1, Hefei, Anhui, Peoples R China.
[5]Xinjiang Med Univ, Affiliated Hosp 1, Urumqi, Peoples R China.
[6]Huazhong Univ Sci & Technol, Tongji Med Coll, Tongji Hosp, Wuhan 430074, Peoples R China.
[7]Zhejiang Prov Peoples Hosp, Hangzhou, Peoples R China.
[8]Zhejiang Univ, Affiliated Hosp 1, Hangzhou 310027, Peoples R China.
[9]Ningxia Med Univ, Gen Hosp, Yinchuan, Peoples R China.
[10]Fujian Med Univ, Ningde Municipal Hosp, Ningde, Peoples R China.
[11]Meishan City Peoples Hosp, Meishan, Peoples R China.
[12]China Three Gorges Univ, Coll Clin Med Sci 1, Yichang, Peoples R China.
[13]Kunming Med Univ, Affiliated Hosp 2, Kunming, Peoples R China.
[14]Shanghai Jiao Tong Univ, Sch Med, Shanghai Peoples Hosp 9, Shanghai 200030, Peoples R China.
[15]Jiangxi Prov Peoples Hosp, Nanchang, Peoples R China.
[16]Harbin Med Univ, Affiliated Hosp 4, Harbin, Peoples R China.
[17]Lanzhou Univ, Hosp 2, Lanzhou 730000, Peoples R China.
[18]Shandong Univ, Shandong Prov Hosp, Jinan 250100, Peoples R China.
[19]Second Mil Med Univ, Shanghai Changzheng Hosp, Shanghai, Peoples R China.
[20]Renshou Cty Peoples Hosp, Renshou, Peoples R China.
[21]Shanxi Med Univ, Affiliated Prov Peoples Hosp, Taiyuan, Peoples R China.
[22]Taixing Peoples Hosp, Taixing, Peoples R China.
[23]Ordos Cent Hosp, Ordos, Inner Mongolia, Peoples R China.
[24]Xinganmeng Peoples Hosp, Wulanhaote, Inner Mongolia, Peoples R China.
[25]Fuyang City Peoples Hosp, Fuyang, Zhejiang, Peoples R China.
[26]Ningbo Yinzhou Second Hosp, Ningbo, Zhejiang, Peoples R China.
[27]Southeast Univ, Zhongda Hosp, Nanjing, Jiangsu, Peoples R China.
[28]Hangzhou Hosp Tradit Chinese Med, Hangzhou, Zhejiang, Peoples R China.
[29]Hebei Med Univ, Hosp 2, Shijiazhuang, Peoples R China.
[30]Guizhou Med Univ, Guizhou Prov Peoples Hosp, Guiyang, Peoples R China.
[31]Peking Univ, Shenzhen Hosp, Shenzhen, Peoples R China.
[32]Hengxian Peoples Hosp, Hengxian, Peoples R China.
[33]Miyun Cty Hosp, Beijing, Peoples R China.
[34]Guangxi Med Univ, Affiliated Hosp 1, Nanning, Peoples R China.
[35]Puer City Peoples Hosp, Puer, Peoples R China.
[36]Zoucheng City Peoples Hosp, Zoucheng, Peoples R China.
[37]Taihe Hosp Tradit Chinese Med, Taihe, Peoples R China.
[38]Shenzhen Longhua New Dist Cent Hosp, Shenzhen, Peoples R China.
[39]Shanghai Jiao Tong Univ, Tongren Hosp, Sch Med, Shanghai 200030, Peoples R China.
[40]Zhongwei City Peoples Hosp, Zhongwei, Peoples R China.
[41]Huaxian Peoples Hosp, Huaxian, Peoples R China.
[42]Suihua City First Hosp, Suihua, Peoples R China.
[43]Fudan Univ, Zhongshan Hosp, Qingpu Branch, Shanghai 200433, Peoples R China.
[44]Qingxuxian City Peoples Hosp, Qingxu, Peoples R China.
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