http://archinte.jamanetwork.com/ en-us Wed, 17 Oct 2012 00:00:00 GMT Tue, 01 Jan 2013 00:43:46 GMT Silverchair editor@archinte.jamanetwork.com webmaster@archinte.jamanetwork.com http://archinte.jamanetwork.com/article.aspx?articleID=1108691 Mon, 13 Feb 2012 00:00:00 GMT Hsu RK, Hsu C. <span class="paragraphSection">While acute kidney injury (AKI), a newer term for acute renal failure, has long been recognized as a common and serious complication of hospitalized patients, the study of AKI epidemiology has lagged. An important advance took place with the introduction of consensus AKI definitions by expert panels—first the Risk, Injury, Failure, Loss, and ESRD (RIFLE) criteria by the Acute Dialysis Quality Initiative in 2004, and then the Acute Kidney Injury Network (AKIN) criteria in 2007. These have allowed researchers to examine AKI epidemiology using a common case definition and to overcome one important limitation in the prior literature when cases were defined using different criteria in different studies, rendering it difficult to interpret variations in reported disease incidence. Since then, several studies have characterized AKI incidence in various settings, with wide range of incidences across different hospital and intensive care unit cohorts, but relatively few studies have examined secular trends in AKI epidemiology.</span> 172 3 253 254 10.1001/archinternmed.2011.1606 http://archinte.jamanetwork.com/article.aspx?articleID=1108691 http://archinte.jamanetwork.com/article.aspx?articleID=1108718 Mon, 13 Feb 2012 00:00:00 GMT Amin AP, Salisbury AC, McCullough PA, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>Acute kidney injury (AKI) is common in patients with acute myocardial infarction (AMI) and is associated with permanent renal impairment and death. Although guidelines increasingly emphasize AKI prevention, whether increased awareness has translated into reduced AKI rates is unclear.<div class="boxTitle">Methods</div>Among 33 249 consecutive hospitalizations in 31 532 unselected patients with AMI across 56 US centers from Cerner Corporation's HealthFacts database, we examined the temporal trends in AKI incidence from 2000 to 2008. Acute kidney injury was defined as an absolute increase in creatinine level of at least 0.3 mg/dL or a relative increase of at least 50% during hospitalization.<div class="boxTitle">Results</div>From 2000 to 2008, the mean age of patients increased (from 66.5 to 68.6 years), as did the known AKI risk factors, including chronic kidney disease, cardiogenic shock, diabetes mellitus, heart failure, coronary angiography, and percutaneous coronary intervention. Despite this, AKI incidence declined from 26.6% in 2000 to 19.7% in 2008 (P < .001). After multivariate adjustment, the trend of decreasing AKI rates persisted (4.4% decline per year; P < .001). In addition, in-hospital mortality also declined over time among patients developing AKI, from 19.9% in 2000 to 13.8% in 2008 (P = .003).<div class="boxTitle">Conclusions</div>In a large national study, AKI incidence in patients hospitalized with AMI declined significantly from 2000 to 2008 despite the aging population and rising prevalence of AKI risk factors. These findings may reflect increased clinician awareness, better risk stratification, or greater use of AKI prevention efforts during this time period.</span> 172 3 246 253 10.1001/archinternmed.2011.1202 http://archinte.jamanetwork.com/article.aspx?articleID=1108718