The changing pattern of referral in acute kidney injury

T. Ali*, A. Tachibana, I. Khan, J. Townend, G. J. Prescott, W. C. Smith, W. Simpson, A. MacLeod

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Aims: To determine the referral rate, factors affecting referral and outcomes across the spectrum of AKI in a population based study.

Methods: We identified all patients with serum creatinine concentrations epsilon 150 mu mol/l (male) or epsilon 130 mu mol/l (female) over a 6-month period. AKI was defined according to the RIFLE classification (risk, injury, failure, loss, end stage renal disease [ESRD]). Clinical information and outcomes were obtained from each patient's case records.

Results: A total of 562 patients were identified as having AKI (incidence 2147 per million population/year [pmp/y]). One hundred and sixty-four patients (29%) were referred to nephrologists-referral rate 627 pmp/y. Forty-nine percent of patients whose serum creatinine rose to > 300 mu mol/l were referred compared with 22% in our previous study of 1997. Forty-eight patients required renal replacement therapy-incidence 184 pmp/y in comparison to 50 pmp/y in our previous study of 1997. Patients had higher odds of referral if they were male, of younger age and were in the F category of the RIFLE classification. Patients had lower odds of referral if they had multiple co-morbid conditions or if they were managed in a hospital without a nephrology service.

Conclusion: There has been a significant rise in the referral rate of patients with AKI to nephrologists but even during our period of study only one-third of such patients were being referred. With rising incidence and increased awareness, the referral rate will certainly rise putting a significant burden on the nephrology services.

Original languageEnglish
Pages (from-to)497-503
Number of pages7
Issue number6
Early online date21 Jan 2011
Publication statusPublished - Jun 2011


  • acute-renal-failure
  • critically-ill patients
  • replacement therapy
  • hospitalized-patients
  • rifle criteria
  • outcomes
  • multicenter
  • mortality
  • epidemiology
  • adults


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