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

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

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / therapy
  • Cohort Studies
  • Female
  • Hospitalization
  • Humans
  • Kidney Failure, Chronic / therapy
  • Logistic Models
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Retrospective Studies
  • Risk
  • United States / epidemiology