A new study has identified the following five clusters of diagnoses that put hospitalized patients at high risk for developing acute kidney injury (AKI): sepsis, heart diseases, polytrauma, liver disease, and cardiovascular surgery.

The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology, also found that hospital-acquired AKI may be largely underestimated.

Previous studies have identified certain risk factors of hospital-acquired AKI, but a comprehensive exploration of all possible diagnoses associated with AKI has never been performed.

A team led by Nicolas Pallet, MD, PhD and Anne-Sophie Jannot, MD, PHD, from Paris Descartes University in France set out to do this in a French urban tertiary academic hospital over a period of 10 years.

The investigators extracted all diagnoses from a clinical data warehouse for patients who were admitted to this hospital between 2006 and 2015 and had at least two plasma creatinine measurements (which are used to diagnose AKI) performed during the first week of their stay.

The researchers then analyzed the association between hospital-acquired AKI and other medical diagnoses. After examining hospital stays for 126,736 unique individuals, the team found the clusters of diagnoses that put patients at high risk for developing AKI in the hospital.

Hospital-acquired acute kidney injury may be underestimated

Only 30% of patients with hospital-acquired AKI (as determined by plasma creatinine measurements) had a corresponding diagnostic AKI code entered into their medical record. This indicates that in most cases, either AKI was not identified and diagnosed by the physician and, consequently, not coded, or AKI was diagnosed but considered a medical issue of minor importance and, therefore, not relevant enough to be encoded.

“Our findings highlight the frequency and the severity of the medical situations associated with hospital-acquired AKI,” said Pallet. “Our results also support the urgent need for efforts to ensure more accurate identification of hospital-acquired AKI.”