Association between regional economic status and renal recovery of dialysis-requiring acute kidney injury among critically ill patients

Abstract

The association between regional economic status and the probability of renal recovery among patients with dialysis-requiring AKI (AKI-D) is unknown. The nationwide prospective multicenter study enrolled critically ill adult patients with AKI-D in four sampled months (October 2014, along with January, April, and July 2015) in Taiwan. The regional economic status was defined by annual disposable income per capita (ADIPC) of the cities the hospitals located. Among the 1,322 enrolled patients (67.1 ± 15.5 years, 36.2% female), 833 patients (63.1%) died, and 306 (23.1%) experienced renal recovery within 90 days following discharge. We categorized all patients into high (n = 992) and low economic status groups (n = 330) by the best cut-point of ADIPC determined by the generalized additive model plot. By using the Fine and Gray competing risk regression model with mortality as a competing risk factor, we found that the independent association between regional economic status and renal recovery persisted from model 1 (no adjustment), model 2 (adjustment to basic variables), to model 3 (adjustment to basic and clinical variables; subdistribution hazard ratio, 1.422; 95% confidence interval, 1.022–1.977; p = 0.037). In conclusion, high regional economic status was an independent factor for renal recovery among critically ill patients with AKI-D.

Predialysis serum lactate levels could predict dialysis withdrawal in Type 1 cardiorenal syndrome patients

“…The study was approved by the National Research Program for Biopharmaceuticals (NRPB)-Institutional Review Board (IRB) (NRPB2014050014) and the IRBs of all participating hospitals. 30 …”

Unsupervised clustering identifies sub-phenotypes and reveals novel outcome predictors in patients with dialysis-requiring sepsis-associated acute kidney injury

“…The NEP-AKI-D study was conducted in ICUs of the 30 participating hospitals in Taiwan. In our previous report, this dataset included 23% of surgical patients and 77% of medical patients [ 43 ]. We extracted a subset of 898 patients who encountered dialysis-requiring SA-AKI and had available serum lactate data upon initializing RRT between 2014 and 2016 ( Table 1 , Figure 6(A) , and Supplemental Methods ).…”

Distinct Subtyping of Successful Weaning from Acute Kidney Injury Requiring Renal Replacement Therapy by Consensus Clustering in Critically Ill Patients

“…First, clinical decisions regarding when to wean off RRT were not based on standardized criteria; rather, decisions were made by the attending physicians according to their clinical judgment. However, this study was conducted at three tertiary care referral hospitals that have historically cooperated for over 10 years and collaborated on many multi-center research studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. This long-term collaboration may have partially reduced the heterogeneity in clinical practice styles with regards to ceasing and re-initiating RRT.…”

“…Successful weaning off RRT is associated with a decreased ICU length of stay and favorable prognosis [4][5][6]. Currently, physicians usually make the decision to wean This study was conducted using a prospectively created AKI database with patients from National Taiwan University Hospital, Chang Gung Memorial Hospital, and Taichung Veterans General Hospital from August 2016 to July 2018 [16][17][18][19][20][21][22]. We enrolled critically ill adult patients with AKI-RRT who met the following criteria: (1) those whose intrinsic renal function had adequately recovered [23]; (2) RRT was no longer consistent with the treatment goals [23]; (3) the indication for starting RRT (azotemia with overt uremic symptoms, refractory hyperkalemia, oliguria or anuria refractory to diuretics, fluid overload refractory to diuretics along with pulmonary edema, severe metabolic acidosis) was in remission; and (4) a trend toward decreasing serum creatinine (sCr), urine output ≥400 mL/24 h with or without diuretics, and improved fluid overload, electrolyte and metabolic status [7,17].…”