Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001
Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001
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DOI：
10.1681/asn.2005060668
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发表时间：
2006-04-01
影响因子：
13.6
通讯作者：
Collins, Allan J.
中科院分区：
文献类型：
--
作者：
Xue, Jay L.;Daniels, Frank;Collins, Allan J.
本研究的目的是确定医疗保险受益人中急性肾功能衰竭（ARF）的发病率和死亡率。数据来自1992年至2001年期间住院的医疗保险受益人（5，403，015出院），来自5%的医疗保险索赔样本。1992年至2001年，ARF的总体发病率为23.8例/1000例出院，发病率每年约增加11%。年龄较大、男性和黑人与ARF密切相关（P < 0.0001）。出院时无ARF的总体院内死亡率为4.6%，出院时ARF编码为主要诊断的死亡率为15.2%，出院时ARF为次要诊断的死亡率为32.6%。出院时需要肾透析的ARF患者的院内死亡率为32.9%，不需要透析的ARF患者的院内死亡率为27.5%。入院后90 d内死亡率为13.1%的出院无ARF，34.5%的出院ARF编码为主要诊断，48.6%的出院ARF作为次要诊断。ARF患者出院后更容易出现重症监护和其他急性器官功能障碍（P < 0.0001）。出院时有无ARF，入院后90天内死亡率呈下降趋势。总之，ARF在医疗保险受益人中的发病率一直在增加。那些年龄较大，男性和黑人更有可能患有ARF。这些数据表明ARF是住院患者发病率和死亡率的主要因素。
This study's objective was to determine the incidence and mortality of acute renal failure (ARF) in Medicare beneficiaries. Data were from hospitalized Medicare beneficiaries (5,403,015 discharges) between 1992 and 2001 from the 5% sample of Medicare claims. For 1992 to 2001, the overall incidence rate of ARF was 23.8 cases per 1000 discharges, with rates increasing by approximately 11% per year. Older age, male gender, and black race were strongly associated (P < 0.0001) with ARF. The overall in-hospital death rate was 4.6% in discharges without ARF, 15.2% in discharges with ARF coded as the principal diagnosis, and 32.6% in discharges with ARF as a secondary diagnosis. In-hospital death rates were 32.9% in discharges with ARF that required renal dialysis and 27.5% in those with ARF that did not require dialysis. Death within 90 d after hospital admission was 13.1% in discharges without ARF, 34.5% in discharges with ARF coded as the principal diagnosis, and 48.6% in discharges with ARF as a secondary diagnosis. Discharges with ARF were more (P < 0.0001) likely to have intensive care and other acute organ dysfunction than those without ARF. For discharges both with and without ARF, rates for death within 90 d after hospital admission showed a declining trend. In conclusion, the incidence rate of ARF in Medicare beneficiaries has been increasing. Those of older age, male gender, and black race are more likely to have ARF. These data show ARF to be a major contributor to morbidity and mortality in hospitalized patients.