Abstract
The association between regional economic status and the probability of renal recovery among patients with dialysis-requiring AKI (AKI-D) is unknown. The nationwide prospective multicenter study enrolled critically ill adult patients with AKI-D in four sampled months (October 2014, along with January, April, and July 2015) in Taiwan. The regional economic status was defined by annual disposable income per capita (ADIPC) of the cities the hospitals located. Among the 1,322 enrolled patients (67.1 ± 15.5 years, 36.2% female), 833 patients (63.1%) died, and 306 (23.1%) experienced renal recovery within 90 days following discharge. We categorized all patients into high (n = 992) and low economic status groups (n = 330) by the best cut-point of ADIPC determined by the generalized additive model plot. By using the Fine and Gray competing risk regression model with mortality as a competing risk factor, we found that the independent association between regional economic status and renal recovery persisted from model 1 (no adjustment), model 2 (adjustment to basic variables), to model 3 (adjustment to basic and clinical variables; subdistribution hazard ratio, 1.422; 95% confidence interval, 1.022–1.977; p = 0.037). In conclusion, high regional economic status was an independent factor for renal recovery among critically ill patients with AKI-D.
Highlights
The association between regional economic status and the probability of renal recovery among patients with dialysis-requiring Acute kidney injury (AKI) (AKI-D) is unknown
We demonstrated the association between annual disposable income per capita (ADIPC) and the probability of renal recovery by the nonlinear generalized additive model (GAM) plot with adjustment to age, gender, baseline estimated glomerular filtration rate, ventilator support, and sequential organ failure assessment (SOFA) at renal replacement therapy (RRT) initiation
To the best of our knowledge, the current nationwide study is an unprecedented study that found that the hospital located in the cities with high average ADIPC, comparing to those in the city with lower value, independently associated with a higher probability of renal recovery among critically ill patients with AKI-D
Summary
The association between regional economic status and the probability of renal recovery among patients with dialysis-requiring AKI (AKI-D) is unknown. High regional economic status was an independent factor for renal recovery among critically ill patients with AKI-D. It is well known that compared to renal recovery, the non-recovery of kidney function after AKI is associated with higher mortality and economic burden[8]. The association between economic status and renal recovery probability is difficult to be determined meaningfully because of the foundational differences in etiology of AKI, practice pattern of AKI treatment, and the health care infrastructure, not to mention the significant under-report of data in lower-income r egions[14]
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