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Clin J Am Soc Nephrol. 2016 Jan 7;11(1):14-20. doi: 10.2215/CJN.04520415. Epub 2015 Dec 18.

Exploring Potential Reasons for the Temporal Trend in Dialysis-Requiring AKI in the United States.

Author information

1
Departments of Medicine, Division of Nephrology, raymond.hsu@ucsf.edu.
2
Epidemiology and Biostatistics, and.
3
Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan;
4
Division of Diabetes Translation, Centers for Disease and Control and Prevention, Atlanta, Georgia;
5
Medicine, University of California, San Francisco, San Francisco, California; Department of Medicine, San Francisco General Hospital, San Francisco, California.
6
Departments of Medicine, Division of Nephrology.

Abstract

BACKGROUND AND OBJECTIVES:

The population incidence of dialysis-requiring AKI has risen substantially in the last decade in the United States, and factors associated with this temporal trend are not well known.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We conducted a retrospective cohort study using data from the Nationwide Inpatient Sample, a United States nationally representative database of hospitalizations from 2007 to 2009. We used validated International Classification of Diseases, Ninth Revision codes to identify hospitalizations with dialysis-requiring AKI and then, selected the diagnostic and procedure codes most highly associated with dialysis-requiring AKI in 2009. We applied multivariable logistic regression adjusting for demographics and used a backward selection technique to identify a set of diagnoses or a set of procedures that may be a driver for this changing risk in dialysis-requiring AKI.

RESULTS:

From 2007 to 2009, the population incidence of dialysis-requiring AKI increased by 11% per year (95% confidence interval, 1.07 to 1.16; P<0.001). Using backward selection, we found that the temporal trend in the six diagnoses, septicemia, hypertension, respiratory failure, coagulation/hemorrhagic disorders, shock, and liver disease, sufficiently and fully accounted for the temporal trend in dialysis-requiring AKI. In contrast, temporal trends in 15 procedures most commonly associated with dialysis-requiring AKI did not account for the increasing dialysis-requiring AKI trend.

CONCLUSIONS:

The increasing risk of dialysis-requiring AKI among hospitalized patients in the United States was highly associated with the changing burden of six acute and chronic conditions but not with surgeries and procedures.

KEYWORDS:

acute kidney injury; cohort studies; dialysis; epidemiology; humans; incidence; renal dialysis; retrospective studies; sepsis; temporal trend

Comment in

PMID:
26683890
PMCID:
PMC4702231
DOI:
10.2215/CJN.04520415
[Indexed for MEDLINE]
Free PMC Article

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