Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States

Abstract

Background: Dialysis-requiring acute kidney injury (AKI-D) is a documented complication of hospitalization and procedures. Temporal incidence of AKI-D and related hospital mortality in the US population has not been recently characterized. We describe the epidemiology of AKI-D as well as associated in-hospital mortality in the US. Methods: Retrospective cohort of a national discharge data (n = 86,949,550) from the Healthcare Cost and Utilization Project's National Inpatient Sample, 2001-2011 of patients' hospitalization with AKI-D. Primary outcomes were AKI-D and in-hospital mortality. We determined the annual incidence rate of AKI-D in the US from 2001 to 2011. We estimated ORs for AKI-D and in-hospital mortality for each successive year compared to 2001 using multiple logistic regression models, adjusted for patient and hospital characteristics, and stratified the analyses by sex and age. We also calculated population-attributable risk of in-hospital mortality associated with AKI-D. Results: The adjusted odds of AKI-D increased by a factor of 1.03 (95% CI 1.02-1.04) each year. The number of AKI-D-related (19,886-34,195) in-hospital deaths increased almost 2-fold, although in-hospital mortality associated with AKI-D (28.0-19.7%) declined significantly from 2001 to 2011. Over the same period, the adjusted odds of mortality for AKI-D patients were 0.60 (95% CI 0.56-0.67). Population-attributable risk of mortality associated with AKI-D increased (2.1-4.2%) over the study period. Conclusions: The incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly.

Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine (sCr) for acute kidney injury (AKI) diagnosis

“…[ 26 ] From 2001 to 2011, data from US centers suggest that while the prevalence of dialysis-requiring acute kidney injury has increased, the mortality rate has decreased (from 28.0 to 19.7%). [ 27 ] In addition, patients with AKI have a higher risk for developing other non-renal co-morbidities [ 28 ] and when present in conjunction with other conditions, AKI is associated with higher mortality. [ 2 , 29 , 30 ] Although no treatment to reverse AKI exists, early detection assists pre-emptive assignment of patients to higher levels of care.…”

Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit

“…( 27 ) One study in the United States mentions that despite an increase in the incidence of AKI requiring RRT, hospital mortality in this group of patients has decreased. ( 28 )…”

Predictors of post‐hospitalization recovery of renal function among patients with acute kidney injury requiring dialysis

“…[1][2][3] Among survivors, 10% to 30% of patients will remain dialysis-dependent at the time of hospital discharge. [3][4][5] Recent studies suggest that the incidence of AKI-D is rising but survival may be improving, 6,7 and therefore increasing numbers of AKI patients will require outpatient dialysis.…”