The exact incidence of ATN has not been established primarily because of the difference in definition and characteristics of assessed patients. For example, the terms acute kidney injury (AKI) and ATN are often mistakenly interchanged.[5]Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: epidemiology, diagnosis, and management. Chest. 2005 Oct;128(4):2847-63.
http://www.ncbi.nlm.nih.gov/pubmed/16236963?tool=bestpractice.com
Nevertheless, ATN has been estimated to account for 76% of AKI cases in critical care units.[5]Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: epidemiology, diagnosis, and management. Chest. 2005 Oct;128(4):2847-63.
http://www.ncbi.nlm.nih.gov/pubmed/16236963?tool=bestpractice.com
AKI is a common diagnosis. It may be overestimated in cases of unrecognised chronic kidney disease, or underestimated in patients with subclinical manifestations.[6]Hoste EAJ, Kellum JA, Selby NM, et al. Global epidemiology and outcomes of acute kidney injury. Nat Rev Nephrol. 2018 Oct;14(10):607-25.
http://www.ncbi.nlm.nih.gov/pubmed/30135570?tool=bestpractice.com
The incidence of AKI is also highly variable due to the different definitions developed over the past decade. It has been estimated to affect 2-3 people per 1000 individuals in the US, affecting older individuals in a greater proportion.[1]Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting. Nat Rev Nephrol. 2018 Apr;14(4):217-30.
http://www.ncbi.nlm.nih.gov/pubmed/29355173?tool=bestpractice.com
[7]Kellum JA, Bellomo R, Ronco C. Kidney attack. JAMA. 2012 Jun 6;307(21):2265-6.
http://www.ncbi.nlm.nih.gov/pubmed/22572776?tool=bestpractice.com
The rate of AKI in 2011 among US Medicare patients aged 66 to 69 years was 14.9 per 1000 individuals, increasing to 18.8 per 1000 individuals in patients aged 70 to 74 years and 35.9 per 1000 in individuals ≥85 years.[1]Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting. Nat Rev Nephrol. 2018 Apr;14(4):217-30.
http://www.ncbi.nlm.nih.gov/pubmed/29355173?tool=bestpractice.com
[8]United States Renal Data System. Chapter 6: Acute kidney injury. In: 2013 USRDS annual data report: Atlas of chronic kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases;2013:95-106.
https://www.usrds.org/media/1490/v1_ch6_13.pdf
In the UK, the incidence has been described as high as 15 in 1000 adults per year.[1]Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting. Nat Rev Nephrol. 2018 Apr;14(4):217-30.
http://www.ncbi.nlm.nih.gov/pubmed/29355173?tool=bestpractice.com
[9]Bedford M, Stevens PE, Wheeler TW, et al. What is the real impact of acute kidney injury? BMC Nephrol. 2014 Jun 21;15:95.
https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-15-95
http://www.ncbi.nlm.nih.gov/pubmed/24952580?tool=bestpractice.com