In-Hospital Mortality From Dialysis-Requiring AKI Declining

Patients were 40% less likely to die in 2011 compared with 2001, study finds.
Patients were 40% less likely to die in 2011 compared with 2001, study finds.

Although the incidence of acute kidney injury requiring dialysis (AKI-D) has increased in the United States, in-hospital mortality associated with the condition has decreased significantly, new findings suggest.

Using the Healthcare Cost and Utilization Project's National Inpatient Sample, Jeremiah R. Brown, PhD, MS, of Dartmouth-Hitchcock Medical Center in Lebanon, NH, and collaborators retrospectively studied nearly 86,949,550 hospitalizations from 2001 to 2011. During this time, 282,212 hospitalizations were associated with AKI-D.

The incidence of AKI-D increased more than 2-fold during the study period, from 71,119 cases in 2001 to 173,205 cases in 2011, Dr Brown's group reported in the American Journal of Nephrology (2016;43:261-270). The adjusted odds of AKI-D increased by 3% per year. In-hospital mortality associated with AKI-D decreased from 28% to 19.7% from 2001 to 2011. Compared with 2001, the adjusted odds of in-hospital death from AKI-D in 2011 decreased by 40%.

In a discussion of the implications of the findings, the authors said “they reinforce the recognition of an increasing incidence of AKI requiring dialysis therapy and that efforts should continue to minimize risk of AKI and prevent the complications associated with AKI.”

They noted that the decrease in AKI-D mortality is encouraging, “but it is important to understand that the changes we have made in care over the last decade have resulted in this improvement.”

Dr. Brown and his colleagues pointed out that mortality in chronic maintenance dialysis also has decreased over the last decade “despite the paucity of randomized trials which have shown a benefit of any specific intervention; therefore it is possible that multiple changes/improvements over time have combined to improve outcomes.”

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