• Masao Iwagami, Hideo Yasunaga, Hiroki Matsui, Hiromasa Horiguchi, Kiyohide Fushimi, Eisei Noiri, Masaomi Nangaku, and Kent Doi.
• Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan.
• Nephrology (Carlton). 2017 Aug 1; 22 (8): 617-623.

AimWe aimed to estimate the burden of end-stage renal disease (ESRD) among patients admitted to intensive care units (ICUs), by comparing hospital outcomes between patients with and without ESRD.MethodsUsing the Japanese Diagnosis Procedure Combination database, we identified patients aged 20 years or older who were admitted to ICUs for ≥3 days (2 nights) in 2011. We created a matched cohort of patients with and without ESRD for hospital, age, sex, main diagnosis category, and ICU admission type (medical or surgical) at a maximum ratio of 1:3. For these matched patients, we compared patient characteristics, treatment regimens at ICU admission, and hospital outcomes. We also performed a multivariable logistic regression analysis for the associations between ESRD and 28-day (counting from ICU admission) and in-hospital mortality.ResultsAmong the 164 423 eligible patients, 7998 (4.9%) had ESRD, from which 5228 ESRD and 12 274 non-ESRD patients were matched for the aforementioned factors. Compared to non-ESRD patients, ESRD patients were on more intensive treatment regimens, including mechanical ventilation, vasoactive drugs, and blood transfusion. Patients with ESRD showed significantly higher ICU, 28-day, and in-hospital mortality and longer lengths of stay in the ICU and hospital (28-day mortality: 11.7% vs. 8.3%; P < 0.001, in-hospital mortality: 21.1% vs. 12.0%; P < 0.001). After adjusting for confounding factors, ESRD was independently associated with 28-day mortality (adjusted odds ratio: 1.36, 95% confidence interval [CI]: 1.22-1.52) and in-hospital mortality (adjusted odds ratio: 1.85, 95% CI: 1.69-2.02).ConclusionThis study involving the Japanese national inpatient database, with a matched-pair cohort design, suggested that ESRD is an important burden in the critical care setting.© 2016 Asian Pacific Society of Nephrology.

30 keywords...

hide…