Analysis of missed diagnosis of acute kidney injury in non-nephrological hospitalized adult patients

Objective To raise the awareness of acute kidney injury (AKI) and improve the level of diagnosis. Methods All the hospitalized adult patients in the Affiliated People's Hospital of Shanxi Medical University from January 2012 to July 2013 were screened. Those patients diagnosed as AKI were retrospectively analyzed in terms of incidence, the rate of missed diagnosis, etiology, distribution and prognosis of AKI. Results (1) The incidence of AKI in the patients was 0.67% (381/56 835), the ratio of male to female was 1.91∶1, and the average age was (63.45±16.95) years. (2)There were 321 cases diagnosed as pre-renal AKI (84.25%), 42 cases diagnosed as renal AKI (11.02%) and 18 cases diagnosed as post-renal AKI (4.72%). (3)There were 189 cases(49.61%) missed diagnosed among all the screened cases. The rates of missed diagnosis in neurosurgery, general surgery and cardiac surgery department was 62.96%, 59.09% and 50.00%, in cardiology, respiratory and neurology department was 50.00%, 50.00% and 45.45% respectively. (4) Multivariate Logistic regression analysis showed that hypertension [odds ratio(OR)=1.631], renal replacement therapy(RRT)(OR=23.256) and oliguria history (OR=1.936) were independent risk factors of missed AKI diagnosis． Conclusion The missed diagnosis rate of AKI is high and has certain characteristics in different departments. Hypertension, RRT and oliguria history are independent impact factors of missed AKI diagnosis．