Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

Waikar, Sushrut S.; Curhan, Gary C.; Wald, Ron; McCarthy, Ellen P.; Chertow, Glenn M.

doi:10.1681/asn.2005091017

Cited by 526 publications

(430 citation statements)

References 40 publications

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“…However, we feel that the limitations associated with ICD-9-CM codes, the use of which is necessary for analysis of the KID, are outweighed by the ability to generate such a large, comprehensive AKI cohort. Notably, although the use of ICD-9-CM codes has yet to be validated in children, this approach has been successfully used in adults (43)(44)(45). Validating these codes in children is an important subsequent step in pediatric AKI research.…”

Section: Discussionmentioning

confidence: 99%

AKI in Hospitalized Children

Sutherland

Ji²,

Sheikhi³

et al. 2013

Clinical Journal of the American Society of Nephrology

229

154

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SummaryBackground and objectives Although AKI is common among hospitalized children, comprehensive epidemiologic data are lacking. This study characterizes pediatric AKI across the United States and identifies AKI risk factors using high-content/high-throughput analytic techniques.Design, setting, participants, & measurements For the cross-sectional analysis of the 2009 Kids Inpatient Database, AKI events were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographics, incident rates, and outcome data were analyzed and reported for the entire AKI cohort as well as AKI subsets. Statistical learning methods were applied to the highly imbalanced dataset to derive AKI-related risk factors.Results Of 2,644,263 children, 10,322 children developed AKI (3.9/1000 admissions). Although 19% of the AKI cohort was #1 month old, the highest incidence was seen in children 15-18 years old (6.6/1000 admissions); 49% of the AKI cohort was white, but AKI incidence was higher among African Americans (4.5 versus 3.8/1000 admissions). In-hospital mortality among patients with AKI was 15.3% but higher among children #1 month old (31.3% versus 10.1%, P,0.001) and children requiring critical care (32.8% versus 9.4%, P,0.001) or dialysis (27.1% versus 14.2%, P,0.001). Shock (odds ratio, 2.15; 95% confidence interval, 1.95 to 2.36), septicemia (odds ratio, 1.37; 95% confidence interval, 1.32 to 1.43), intubation/mechanical ventilation (odds ratio, 1.2; 95% confidence interval, 1.16 to 1.25), circulatory disease (odds ratio, 1.47; 95% confidence interval, 1.32 to 1.65), cardiac congenital anomalies (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.23), and extracorporeal support (odds ratio, 2.58; 95% confidence interval, 2.04 to 3.26) were associated with AKI.Conclusions AKI occurs in 3.9/1000 at-risk US pediatric hospitalizations. Mortality is highest among neonates and children requiring critical care or dialysis. Identified risk factors suggest that AKI occurs in association with systemic/multiorgan disease more commonly than primary renal disease.

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Section: Discussionmentioning

confidence: 99%

AKI in Hospitalized Children

Sutherland

Ji²,

Sheikhi³

et al. 2013

Clinical Journal of the American Society of Nephrology

229

154

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“…In the nonsurgical setting, the incidence of acute dialysis has steadily increased over the last 15 years, and patients are now more likely to survive to discharge from hospital. [3][4][5] Similarly, in the surgical setting, the incidence of acute dialysis appears to be increasing over time, [6][7][8][9][10] with declining inhospital mortality. 8,10,11 Although previous studies have improved our understanding of the epidemiology of acute dialysis in the surgical setting, several questions remain.…”

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confidence: 99%

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

Siddiqui

Coca

Devereaux

et al. 2012

CMAJ

Self Cite

119

116

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Research CMAJBackground: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. Methods:We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.Results: A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time.Interpretation: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed. Abstract

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“…It is conceivable that, besides differences in severity of illness (community-acquired versus hospital-acquired versus intensive care unit [ICU]-acquired AKI) and the type of center reporting the data (primary versus secondary or tertiary hospitals, cardiac surgery versus no cardiac surgery patients), these remarkable differences in incidence and prognosis are to a large extent due to the "babylonic" confusion that is created by a lack of a universal definition of AKI. The recently reported changes in epidemiology and outcomes of patients with AKI, based on analysis of large administrative databases (5,6), probably are influenced at least partially by the changing paradigm of the definition of AKI (7).…”

mentioning

confidence: 99%

Defining Acute Renal Failure

Biesen

Vanholder²,

Lameire³

2006

Clinical Journal of the American Society of Nephrology

156

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The introduction of the RIFLE classification has increased the conceptual understanding of the acute kidney injury (AKI) syndrome, and this classification has been successfully tested in a number of clinical studies. This review discusses the strengths and weaknesses of the RIFLE classification and suggests additional parameters to broaden future definitions of AKI. These definitions should not only focus on kidney function alone, but also include parameters describing the origin of the patient, the most important causal factors responsible for AKI and information on the pre-existing kidney function. This more complete definition should lead to a decrease in the variability of the results of epidemiological studies and of future clinical trials in AKI populations.

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Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

Cited by 526 publications

References 40 publications

AKI in Hospitalized Children

AKI in Hospitalized Children

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

Defining Acute Renal Failure

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