Cross-sectional survey of acute kidney injury in adult patients in the Chinese ICUs (CARE-AKI)

Background and Objectives Acute kidney injury (AKI) has been considered to be a disease that seriously threatens the safety and quality of life, causing a huge economic burden to society, especially for critically ill patients. However, there is currently a lack of data on AKI in adult patients in the Chinese ICUs. This study aimed to assess the prevalence, clinical characteristics, and regional distribution of AKI, as well as the use of renal replacement therapy, in this population. Methods A cross-sectional survey was conducted between December 2018 and January 2019 among 5236 critically ill patients aged ≥18 years, across 35 ICUs in 30 provinces of China. Medical records were reviewed for each participant. AKI was diagnosed according to the 2012 Kidney Disease: Improving Global Outcomes AKI definition. Results A total of 805 (15.4%) patients with AKI were ultimately identified, including 370 patients with stage I. The overall missed diagnosis rate was 26.5%, highest in the northeastern region. Nearly half (47.9%) of the AKI patients had underlying cardiovascular disease. ICU length of stay (6.5 days vs . 2.0 days, P < 0.001) and ICU cost (CNY 58,027 vs . CNY 24,603, P < 0.001) were significantly increased in AKI patients compared with non-AKI patients. And the all-cause mortality rate of AKI patients was 31.8%. Conclusions The prevalence of AKI and the missed diagnosis rate were high among critically ill adults in Chinese ICUs. It is urgent to standardize and popularize the diagnostic criteria and procedures.