Risk Factors for Community-Acquired Acute Kidney Injury in Medical Patients: A Nested Case-Control Study

Abstract

<b><i>Introduction:</i></b> Research about the risk factors associated with community-acquired acute kidney injury (CA-AKI) in acute medical diseases is scarce. Data extrapolation from surgical to medical illnesses is questionable. <b><i>Objectives:</i></b> To evaluate potential risk factors and hospital outcomes associated with a CA-AKI in medical illnesses. <b><i>Methods:</i></b> We performed an unmatched nested case-control study from a previous prospective cohort study. We included adult patients with acute illnesses treated with internal medicine. Cases were defined as patients with a CA-AKI diagnosis upon hospital admission, and controls included patients from the same cohort who did not develop AKI during the first 5 days of hospitalisation. A logistic regression model was used to assess the association between potential risk factors and ­CA-AKI. <b><i>Results:</i></b> A total of 868 patients were included in the study (223 cases and 645 controls). The median age was 65 years (interquartile range 50–78). In a logistic regression model, the risk factors associated with CA-AKI included chronic kidney disease (CKD; OR 6.27; 95% CI 2.95–13.3, <i>p</i> &#x3c; 0.001), ≥65 years old (OR 1.72; 95% CI 1.16–2.57, <i>p</i> = 0.007), acute bacterial infection (OR 1.95; 95% CI 1.36–2.80, <i>p</i> &#x3c; 0.001), hypovolaemia (OR 1.88; 95% CI 1.32–2.69, <i>p</i> &#x3c; 0.001), pre-hospital nephrotoxic drugs (OR 1.77; 95% CI 1.23–2.55, <i>p</i> = 0.002), anaemia (OR 1.49; 95% CI 1.03–2.14, <i>p</i> = 0.031) and systolic blood pressure (SBP) &#x3c;107 mm Hg (OR 2.25; 95% CI 1.38–3.67, <i>p</i> = 0.001). A significant interaction between CKD and age was found (<i>p</i> = 0.017) and included in the model (patients with CKD and ≥65 years old [OR 10.85; 95% CI 4.14–28.41, <i>p</i> &#x3c; 0.001]). The area under the receiver operating characteristic curve of the final model was 0.743. <b><i>Conclusions:</i></b> CKD is strongly associated with CA-AKI upon hospital admission in medical illnesses patients. Older age enhances the risk of CA-AKI in patients with CKD. Other risk factors include pre-hospital nephrotoxic drugs, acute bacterial infection, anaemia, low SBP and hypovolaemia.