• Raymond K Hsu, Charles E McCulloch, Michael Heung, Rajiv Saran, Vahakn B Shahinian, Meda E Pavkov, Nilka Ríos Burrows, Neil R Powe, Chi-yuan Hsu, and Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team.
• Departments of Medicine, Division of Nephrology, raymond.hsu@ucsf.edu.
• Clin J Am Soc Nephrol. 2016 Jan 7; 11 (1): 14-20.

Background And ObjectivesThe 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, & MeasurementsWe 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.ResultsFrom 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.ConclusionsThe 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.Copyright © 2016 by the American Society of Nephrology.

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