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Published ahead of print on September 21, 2005
J Am Soc Nephrol 16: 3365-3370, 2005
© 2005 American Society of Nephrology
doi: 10.1681/ASN.2004090740
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Clinical Nephrology

Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients

Glenn M. Chertow*, Elisabeth Burdick{dagger}, Melissa Honour{dagger}, Joseph V. Bonventre{ddagger} and David W. Bates{dagger}

* Division of Nephrology, Departments of Medicine, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, California; {dagger} Division of General Internal Medicine; and {ddagger} Renal Division, Department of Medicine and Harvard-MIT Division of Health Sciences and Technology, Brigham and Women’s Hospital, Harvard Medical School, Partners HealthCare System, Boston, Massachusetts

Address correspondence to: Dr. Glenn M. Chertow, University of California San Francisco, Department of Medicine Research, UCSF Laurel Heights, Suite 430, 3333 California Street, San Francisco, CA 94118-1211. Phone: 415-476-2173; Fax: 415-476-9531; chertowg{at}medicine.ucsf.edu

Received for publication September 8, 2004. Accepted for publication July 27, 2005.

The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., ≥2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., ≥0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr ≥0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly $7500 in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.


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