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This study examines the incidence, unrecognized rate, and outcomes of AKI in adults at a large public Chinese hospital from 2010 to 2023. AKI rates were calculated, and outcomes were assessed using follow-up records. Multivariate logistic regression identified risk factors for unrecognized AKI. Among 2,790,540 patients, 5,080 met the AKI criteria, with an overall incidence of 0.18% (0.78% in hospitalizations, 0.05% in outpatients). The unrecognized AKI was 76.3%. In this group, 75% were stage 1, 16.7% stage 2, and 8.3% stage 3. Orthopedics had the highest unrecognized rate (94.5%) and ICUs the lowest (55.77%). Unrecognition of AKI improved from 90.3% in 2010\u20132011 to 70.2% in 2022\u20132023. AKI stage progression was linked to poorer survival. Patients with recognized AKI recovered faster than those with unrecognized AKI (8.0 vs. 9.0 days, p\u2009&lt;\u20090.001). The mean follow-up time was 15.8 days, with similar rates at 28 and 90 days post-AKI for both groups. Risk factors for unrecognized AKI included lower AKI stage, baseline creatinine, absence of shock\/heart disease\/hypertension, and non-nephrology\/surgery admissions. Non-nephrology physicians\u2019 unfamiliarity with AKI guidelines may contribute to low awareness. Improved early detection and monitoring in high-risk groups are needed.<\/jats:p>","DOI":"10.1038\/s41598-025-88732-8","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T01:40:03Z","timestamp":1740102003000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Unexpectedly high rate of unrecognized acute kidney injury and its trend over the past 14 years"],"prefix":"10.1038","volume":"15","author":[{"given":"Lina","family":"Han","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxiao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingfan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolan","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zimeng","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"88732_CR1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/kisup.2012.1","volume":"2","author":"J Kellum","year":"2012","unstructured":"Kellum, J. et al. 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