Inequalities in outcomes of acute kidney injury in England

Background: Renal replacement is managed by renal specialists and is well documented in national registries. In contrast, nation-wide data on acute kidney injury (AKI) are difficult to capture as it presents in many different ways to all acute hospitals. This paucity impacts on the coordination of appropriate services. Aims: We have set out to use all the information submitted by all hospitals in England to identify emergency patients in whom AKI was a major contributor to their hospital stay. We then examined workload in relation to specialist provision and outcomes of care. Design and Methods: All English hospitals submit a sequential list of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD 10) codes to describe the diagnosis of each admission. An algorithm was applied to all emergency admissions over a 2-year period to identify AKI. The level of renal specialist care available within each hospital trust was compared with patient outcomes, including 30-day mortality. Results: The incidence of AKI was 1.34% of all emergency admissions. The numbers and types of AKI cases were similar in all trusts, regardless of the service available. Thirty-day mortality was 30.0%. More than half the acute hospitals did not have on-site renal specialists and their AKI mortality rates were significantly higher (P < 0.001). These differences persisted despite adjusting for multiple variables. Conclusions: The country has created specialist renal units in 45% of hospital trusts, but AKI presents as emergencies to all hospitals and there is an increased risk of mortality in the 55% of trusts without renal specialists.