Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients

• Published in: Journal of the American Society of Nephrology Vol. 16; no. 11; pp. 3365 - 3370
• Main Authors: Chertow, Glenn M., Burdick, Elisabeth, Honour, Melissa, Bonventre, Joseph V., Bates, David W.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.11.2005
• Subjects: Acute Disease; Biological and medical sciences; Body Weight; Costs and Cost Analysis; Creatinine - blood; Diagnosis-Related Groups; Female; Hospital Mortality; Humans; Inpatients; Kidney - injuries; Kidneys; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; United States; Urinary system involvement in other diseases. Miscellaneous; Wounds and Injuries - economics; Wounds and Injuries - mortality; United States; North America; America; Kidney disease; Human; Costs; Nephrology; Urinary system disease; Residence time; Mortality; Acute kidney injury; Hospitalization; Epidemiology; Urology; Health economy; Economic aspect; Public health
• ISSN: 1046-6673
• DOI: 10.1681/ASN.2004090740

The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.