Acute Kidney Injury in Adults: An Underdiagnosed Condition

Kristy Washinger; MSN; FNP-BC


Journal for Nurse Practitioners. 2017;13(10):667-674. 

In This Article

Abstract and Introduction


Acute kidney injury (AKI) is a complex disease process that is increasingly common and has an increased rate of adverse outcomes and mortality. It is commonly underdiagnosed in inpatient and community settings by many providers. This article is a comprehensive review of AKI from risk factors to diagnosis to management and follow-up.


A cute kidney injury (AKI) can cause acute loss of kidney function and can occur in multiple settings. It is often underdiagnosed and can range from a minor, temporary loss of kidney function to complete kidney failure. There is an increased rate of adverse outcomes and mortality with AKI. The United States Renal Data System reported that inhospital mortality rates were 9% for Medicare patients ages 66 and older with their first AKI and 13.9% when patients who were discharged to hospice were included.[1] A single episode of AKI can lead to an elevated risk of recurrent AKI, progression of baseline chronic kidney disease (CKD), and progression to end-stage renal disease requiring renal replacement therapy (RRT).[2] The United States Renal Data System calculated that Medicare patients ages 66 and older with an AKI hospitalization had a 48% chance of a recurrent AKI hospitalization within 2 years.[1,3] A review of Veterans Affairs patients noted that less than 50% of AKI cases were coded with the appropriate Current Procedural Terminology code (Figure).[1]


Unadjusted incidence rates of AKI by age and year, Medicare data.1