National Variation in Acute Kidney Injury Diagnosis and Monitoring Across Adult Intensive Care Units in China: A Nationwide Cross-Sectional Survey - 22/09/26

Doi : 10.1016/j.aicoj.2026.100166

Xinran Wang ^a,^b, Xiuhua Zhang ^a,^b, Weiting Zhang ^a,^b, Yu Xin ^a,^b, Pengfei Huang ^a,^b, Yanqi Liu ^a,^b, Kai Zeng ^a,^b, Xianglin Meng ^a,^b, Zhiyong Peng ^c, Wenxiong Li ^d, Zhenjie Hu ^e, Yingzi Huang ^f, Meili Duan ^g, Mingyan Zhao ^a,^b,^{^{1
Mingyan Zhao, Kaijiang Yu, and Changsong Wang are co-corresponding authors. For submission and editorial correspondence, please contact Changsong Wang.},}⁎ , Kaijiang Yu ^a,^b,^{^{1
Mingyan Zhao, Kaijiang Yu, and Changsong Wang are co-corresponding authors. For submission and editorial correspondence, please contact Changsong Wang.},}⁎ , Changsong Wang ^a,^b,^{^{1
Mingyan Zhao, Kaijiang Yu, and Changsong Wang are co-corresponding authors. For submission and editorial correspondence, please contact Changsong Wang.},}⁎

^a Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, No. 23 You Zheng Street, Harbin 150001, Heilongjiang Province, China

^b Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin 150001, China

^c Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, No. 169 East Lake Road, Wuchang District, Wuhan 430071, Hubei Province, China

^d Department of Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China

^e Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei Province, China

^f Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China

^g Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China

^⁎ Corresponding author.

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Abstract

Background

Acute kidney injury (AKI) is common in critically ill patients and strongly associated with adverse outcomes, yet national ICU-level evidence on AKI diagnosis and monitoring in China remains limited.

Methods

We conducted a nationwide anonymous cross-sectional web survey of adult ICUs in China from June 25 to September 26, 2025. The survey assessed AKI diagnosis and staging, UO and SCr monitoring across clinical scenarios, biomarker use, early warning systems, and changes in UO monitoring after AKI. We used multivariable logistic regression to identify factors associated with UO-monitoring practices, with FDR correction for multiple comparisons. An exploratory 0–100-point AKI-MIS summarised ICU-level monitoring implementation, with higher scores indicating broader implementation.

Results

Of 2,002 responses, 1,896 unique adult ICU units were included. AKI diagnosis was reported by 97.9% of ICUs, whereas 63.2% explicitly implemented staging and 75.9% used both UO and SCr for diagnosis. Hourly UO monitoring increased from 49.6% in routine practice to 74.1% in sepsis, 75.0% in AKI, and 77.7% in sepsis-associated AKI. Dynamic UO monitoring was implemented in 14.8% of ICUs; 83.5% reported increased nursing workload, and 69.9% identified workload or insufficient staffing as the main barrier. After FDR correction, geographic region, nurse-to-bed ratio, and baseline monitoring intensity were associated with UO-monitoring practices. The median AKI-MIS was 68.1 (IQR, 60.3–74.9), with higher adjusted scores in teaching hospitals.

Conclusions

Among participating adult ICU units across all 31 provincial-level administrative regions of mainland China, AKI diagnosis and monitoring were widely reported, but substantial heterogeneity remained across monitoring systems. These findings provide a broad descriptive benchmark and identify priorities for strengthening standardisation, risk-responsive escalation, and closed-loop response pathways.

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Keywords : acute kidney injury, intensive care units, urine output monitoring, serum creatinine, critical care, quality improvement, China

Plan

This survey was initiated and supported by the Nephrology Group of the Chinese Society of Critical Care Medicine and the Nephrology Quality Control Group of China National Critical Care Quality Control Centre.