Toggle Main Menu Toggle Search

Open Access padlockePrints

Development and external validation of an acute kidney injury risk score for use in the general population

Lookup NU author(s): Professor Miles WithamORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.comBackground. Improving recognition of patients at increased risk of acute kidney injury (AKI) in the community may facilitate earlier detection and implementation of proactive prevention measures that mitigate the impact of AKI. The aim of this study was to develop and externally validate a practical risk score to predict the risk of AKI in either hospital or community settings using routinely collected data. Methods. Routinely collected linked datasets from Tayside, Scotland, were used to develop the risk score and datasets from Kent in the UK and Alberta in Canada were used to externally validate it. AKI was defined using the Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Multivariable logistic regression analysis was performed with occurrence of AKI within 1 year as the dependent variable. Model performance was determined by assessing discrimination (C-statistic) and calibration. Results. The risk score was developed in 273 450 patients from the Tayside region of Scotland and externally validated into two populations: 218 091 individuals from Kent, UK and 1 173 607 individuals from Alberta, Canada. Four variables were independent predictors for AKI by logistic regression: older age, lower baseline estimated glomerular filtration rate, diabetes and heart failure. A risk score including these four variables had good predictive performance, with a C-statistic of 0.80 [95% confidence interval (CI) 0.80-0.81] in the development cohort and 0.71 (95% CI 0.70-0.72) in the Kent, UK external validation cohort and 0.76 (95% CI 0.75-0.76) in the Canadian validation cohort. Conclusion. We have devised and externally validated a simple risk score from routinely collected data that can aid both primary and secondary care physicians in identifying patients at high risk of AKI.

Publication metadata

Author(s): Bell S, James MT, Farmer CKT, Tan Z, de Souza N, Witham MD

Publication type: Article

Publication status: Published

Journal: Clinical Kidney Journal

Year: 2020

Volume: 13

Issue: 3

Pages: 402-412

Print publication date: 01/06/2020

Online publication date: 16/07/2020

Acceptance date: 01/04/2020

Date deposited: 02/04/2020

ISSN (print): 2048-8505

ISSN (electronic): 2048-8513

Publisher: Oxford University Press


DOI: 10.1093/CKJ/SFAA072


Altmetrics provided by Altmetric