• Ron Wald, Eric McArthur, Neill K J Adhikari, Sean M Bagshaw, Karen E A Burns, Amit X Garg, Ziv Harel, Abhijat Kitchlu, C David Mazer, Danielle M Nash, Damon C Scales, Samuel A Silver, Joel G Ray, and Jan O Friedrich.
• Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences Kidney, Dialysis and Transplantation Program, London, ON, Canada. Electronic address: waldr@smh.ca.
• Am. J. Kidney Dis. 2015 Jun 1;65(6):870-7.

BackgroundDialysis-requiring acute kidney injury (AKI) is common among critically ill patients, but little is known about trends in the incidence and outcomes of this condition over time.Study DesignPopulation-based cohort study.Setting & ParticipantsAll adult patients admitted to an intensive care unit in Ontario, Canada, 1996 to 2010.PredictorYear and era (1996-2000, 2001-2005, and 2006-2010) of cohort entry.OutcomesMortality and dialysis dependence, each evaluated at 90 and 365 days after initiation of dialysis therapy for AKI.MeasurementsThe annual incidence proportion of dialysis-requiring AKI was evaluated and patients with this condition were characterized by era. Associations between era and the outcomes of interest were evaluated with Cox proportional hazards (for time to death) and logistic regression (for dialysis dependence), with adjustment for relevant demographic and clinical variables.ResultsThe annual incidence of dialysis-requiring AKI among critically ill patients increased from 0.8% in 1996 to 3.0% in 2010 (P for trend < 0.001). 90-day mortality declined from 50% in 1996 to 2000 to 45% in 2006 to 2010 (adjusted HR, 0.83 [95% CI, 0.79-0.87] compared to 1996-2000). Dialysis dependence among surviving patients at 90 days was marginally lower in 2006 to 2010 (25.1%) compared to 1996 to 2000 (27.2%), but after adjustment for confounding factors, was not significantly different (adjusted OR, 0.91; 95% CI, 0.80-1.03).LimitationsUnmeasured confounding by factors that may have changed in patients with dialysis-requiring AKI during the different eras; data set does not allow for mechanistic explanation for the findings; and lack of access to laboratory investigations after hospital discharge.ConclusionsThe incidence proportion of dialysis-requiring AKI among critically ill patients increased by almost 4-fold between 1996 and 2010. This was accompanied by a significant decline in mortality, but the risk of long-term dialysis dependence continues to affect a substantial minority of surviving patients with no clear evidence of improvement over time.Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

38 keywords...

hide…