Incidence, predictors, clinical outcomes, and economic burden of recurrent acute kidney injury: a retrospective cohort study

Abstract

Objective

This study aimed to assess the incidence, predictors, mortality, and economic outcomes of recurrent Acute kidney injury (AKI) in Jordan.

Methods

This was a retrospective cohort study that included adult patients who were admitted with AKI to university hospitals in the country from 2010–2019. Recurrent episodes of AKI, laboratory data, baseline medication list, and death dates were retrieved from patient’s medical records. The incidence rate of recurrent AKI was estimated. Predictors of recurrent AKI and mortality during the five years post-discharge was evaluated. Total admission charges were described and evaluated in total and by service provided.

Results

Among 1162 AKI patients, 57 patients (4.9%) died during the index admission (first admission during the study period), and among the survivors, 220 patients were re-hospitalized with a recurrent AKI during five years of follow-up. Patients with higher discharge serum creatinine level (SCr) at index admission had higher odds of AKI recurrence (OR = 1.001). Patients who were on respiratory, antineoplastic, or anticoagulant medications were also more susceptible to recurrence; ORs were 1.69, 2.77, and 4.16, respectively. Patients who were elderly, with recurrent AKI episodes, or with a more extended hospital stay at index admission were more likely to die during the five years post discharge. The median charge of recurrent admissions was higher than the median charge of the index admissions; 1519.17 JOD ($2142.7) versus 1362.85 JOD ($1922.2), respectively.

Conclusions

Recurrent AKI is associated with increased mortality and health expenditures. Higher discharge SCr levels at index admission, and chronic comorbidities are associated with a higher likelihood of AKI recurrence.

Keywords:

• Acute kidney injury (AKI)
• recurrent AKI
• mortality
• charges

Transparency

Declaration of financial/other relationships

The authors have no conflicts of interest to declare. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Altawalbeh S, Wali L, and Alshogran O were involved in the were involved in the study conception and design, data curation, formal analysis, supervision, project administration, funding acquisition, and writing original draft. Hammad E, and Tahaineh L were involved in data interpretation and drafting of the paper. All authors were involved in revising the paper critically for intellectual content. All authors gave the final approval of the version to be published and all authors agree to be accountable for all aspects of the work.

Acknowledgements

Authors are very thankful to Dr. Randa Farah, nephrologist at the Department of Internal Medicine, School of Medicine, The University of Jordan, for the critical review of the manuscript.

Data availability statement

The data are gathered from the medical and financial records of two hospitals. The author can provide more details upon request.

Additional information

Funding

This study is supported by the Deanship of Scientific Research at Jordan University of Science and Technology, grant number 20210180. The funding agency was not involved in the study design, conduct, writing or decision to submit the article for publication.