Risk Assessment of Community-Acquired Acute Kidney Injury: A 10-Year Retrospective Study in a Malaysian Tertiary Hospital.

Community-acquired acute kidney injury (CA-AKI) is an increasingly recognized public health concern, particularly in low- and middle-income countries. It is associated with significant morbidity, mortality, and risk of chronic kidney disease. However, epidemiological data on CA-AKI in Southeast Asia remain limited. This study aimed to evaluate the demographic profile, clinical presentation, etiologies, outcomes, and risk stratification of CA-AKI among adult patients admitted to a tertiary hospital in Malaysia over a 10-year period. A retrospective observational study was conducted using medical records of adult patients (>19 years old) diagnosed with CA-AKI at Hospital Sultanah Nur Zahirah from 2014 to 2023. Data were analyzed for CA-AKI demographics, referral sources, determining the extent of the severity and the risk (Risk = probability X severity score) using Statistical Program for Social Sciences (SPSS) version 27. Out of 306,337 AKI admissions, 293 adult cases met the criteria for CA-AKI (0.1%). Most patients were male (55.3%) and aged above 51 years (74.1%). Infective causes (64.5%) were the leading etiology. Nearly half (47.4%) were diagnosed at KDIGO Stage 1, while 43.4% were in Stage 2 or 3. Hospital mortality was 19.8%, and 57% were readmissions. Risk stratification identified infective causes as having the highest combined probability and severity. CA-AKI predominantly affects older adults with comorbidities and is largely triggered by infections. Despite its low recorded incidence, it poses a serious health burden. Enhanced public education, early detection, and strengthened primary care pathways are essential to reduce preventable CA-AKI cases and improve outcomes.