Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States.
Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States.
复制标题
DOI：
10.1159/000445846
复制
发表时间：
2016
影响因子：
4.2
通讯作者：
Sarnak MJ
中科院分区：
文献类型：
--
作者：
Brown JR;Rezaee ME;Hisey WM;Cox KC;Matheny ME;Sarnak MJ
需要透析的急性肾损伤（AKI-D）是住院和手术的记录并发症。美国人群中AKI-D的时间发病率和相关住院死亡率最近尚未得到表征。我们描述了美国AKI-D的流行病学以及相关的住院死亡率。回顾性队列的国家出院数据（n = 86，949，550）来自医疗保健成本和利用项目的国家住院患者样本，2001年至2011年因需要透析的急性肾损伤住院的患者。主要结局为需要透析的急性肾损伤和住院死亡率。我们确定了2001年至2011年美国AKI-D的年发病率。我们使用多元逻辑回归模型，根据患者和医院特征进行调整，并按性别和年龄分层分析，估计与2001年相比，连续每年AKI-D和住院死亡率的比值比。我们还计算了与AKI-D相关的住院死亡率的人群归因风险。AKI-D的调整后的几率每年增加1.03倍（95% CI：1.02-1.04）。与AKI-D相关的住院死亡人数（19，886至34，195）几乎增加了两倍，尽管与AKI-D相关的住院死亡率（28.0%至19.7%）从2001年至2011年显著下降。在同一时期，AKI-D患者的校正死亡率为0.60（95% CI：0.56-0.67）。在研究期间，与AKI-D相关的人群归因死亡风险增加（2.1%至4.2%）。自2001年以来，美国AKI-D的发病率大幅增加。然而，与AKI-D住院相关的住院死亡率显著下降。
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 U.S. population has not been recently characterized. We describe the epidemiology of AKI-D as well as associated in-hospital mortality in the U.S. Retrospective cohort of a national discharge data (n = 86,949,550) from the Healthcare Cost and Utilization Project’s National Inpatient Sample, 2001 to 2011 of patients hospitalization with dialysis-requiring acute kidney injury. Primary outcomes were dialysis-requiring acute kidney injury and in-hospital mortality. We determined the annual incidence rate of AKI-D in the U.S. from 2001 to 2011. We estimated odds ratios 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. 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 to 34,195) in-hospital deaths increased almost twofold, although in-hospital mortality associated with AKI-D (28.0% to 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% to 4.2%) over the study period. The incidence rate of AKI-D has increased considerably in the U.S. since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly.