1. ¹Department of Medicine, University of California, San Francisco, California, USA
2. ²Division of Nephrology, Kaiser Permanente Medical Center, Oakland, California, USA
3. ³Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
4. ⁴Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA

Correspondence: CY Hsu, Division of Nephrology, University of California, 513 Parnassus Avenue, 672 HSE, Box 0532, San Francisco, California 94143-0532, USA. E-mail: hsuchi@medicine.ucsf.edu

Received 19 September 2007; Revised 11 January 2008; Accepted 30 January 2008; Published online 2 April 2008.

Abstract

Few studies have defined how the risk of hospital-acquired acute renal failure varies with the level of estimated glomerular filtration rate (GFR). It is also not clear whether common factors such as diabetes mellitus, hypertension and proteinuria increase the risk of nosocomial acute renal failure independent of GFR. To determine this we compared 1,746 hospitalized adult members of Kaiser Permanente Northern California who developed dialysis-requiring acute renal failure with 600,820 hospitalized members who did not. Patient GFR was estimated from the most recent outpatient serum creatinine measurement prior to admission. The adjusted odds ratios were significantly and progressively elevated from 1.95 to 40.07 for stage 3 through stage 5 patients (not yet on maintenance dialysis) compared to patients with estimated GFR in the stage 1 and 2 range. Similar associations were seen after controlling for inpatient risk factors. Pre-admission baseline diabetes mellitus, diagnosed hypertension and known proteinuria were also independent risk factors for acute kidney failure. Our study shows that the propensity to develop in-hospital acute kidney failure is another complication of chronic kidney disease whose risk markedly increases even in the upper half of stage 3 estimated GFR. Several common risk factors for chronic kidney disease also increase the peril of nosocomial acute kidney failure.