Incidence and risk factors of acute renal failure

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The incidence of Acute Kidney Injury (AKI) is increasing, with Australian and US Medicare data illustrating striking increases over the decade following 2000. Up to 20% of adult patients experience AKI during their hospitalization, with mortality rates as high as 45%, and AKI is a global healthcare issue that has significant impacts on patients’ quality of life. In the absence of proven therapies to prevent or even treat AKI, it is likely that the current growth in incidence will continue into coming years. Almost all the randomised trial evidence in AKI arises from patients with severe AKI requiring renal replacement therapy (RRT) in the ICU setting. The non-ICU burden of AKI is much larger, such that interventions in this area are likely to have a much greater impact upon AKI globally. In addition, as novel treatments are developed to address the poor outcomes of AKI, these non-ICU patients will be central to the testing of these treatments. Current literature regarding non-ICU AKI are mainly derived from retrospective studies and administrative data. Two large administrative studies have demonstrated an approximate rise in incidence of AKI by 20 episodes per 1000 discharges between 1990 and 2000, with local Australian and New Zealand data also showing similar increases in ICU patients. However, the incidence of AKI in the non-ICU setting using a prospective study is poorly-known due to underreporting, differences in the AKI definition and case mix. The PERFORM-AKI study will provide initial unique insights into the burden of non-ICU AKI and form the basis of understanding the potentially remediable factors that might be amendable to modification in order to improve long-term outcomes of survivors following AKI.

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