The association of socioeconomic status with incidence and outcomes of acute kidney injury

BACKGROUND: Acute kidney injury (AKI) is common and is associated with significant morbidity and mortality. Socioeconomic status may be negatively associated with AKI as some risk factors for AKI such as chronic kidney disease, diabetes and heart failure are socially distributed. This study explored the socioeconomic gradient of the incidence and mortality of AKI, after adjusting for important mediators such as comorbidities. METHODS: Linked primary care and laboratory data from two large acute hospitals in the south of England, sourced from the Care and Health Information Analytics database, were used to identify AKI cases over a 1-year period (2017–18) from a population of 580 940 adults. AKI was diagnosed from serum creatinine patterns using a Kidney Disease: Improving Global Outcomes-based definition. Multivariable logistic regression and Cox proportional hazard models adjusting for age, sex, comorbidities and prescribed medication (in incidence analyses) and AKI severity (in mortality analyses), were used to assess the association of area deprivation (using Index of Multiple Deprivation for place of residence) with AKI risk and all-cause mortality over a median (interquartile range) of 234 days (119–356). RESULTS: Annual incidence rate of first AKI was 1726/100 000 (1.7%). The risk of AKI was higher in the most deprived compared with the least deprived areas [adjusted odds ratio = 1.79, 95% confidence interval (CI) 1.59–2.01 and 1.33, 95% CI 1.03–1.72 for <65 and >65 year old, respectively] after controlling for age, sex, comorbidities and prescribed medication. Adjusted risk of mortality post first AKI was higher in the most deprived areas (adjusted hazard ratio = 1.20, 95% CI 1.07–1.36). CONCLUSIONS: Social deprivation was associated with higher incidence of AKI and poorer survival even after adjusting for the higher presence of comorbidities. Such social inequity should be considered when devising strategies to prevent AKI and improve care for AKI patients.