Abstract
BackgroundAlthough no specific treatment facilitates renal tubular regeneration in acute kidney injury (AKI), the rapid increase in aging populations with more comorbidities and advances in critical care management are expected to change the epidemiology of AKI. However, few recent studies dissected the current epidemiologic characteristics of critically ill patients with AKI. We investigated recent epidemiologic changes in severe AKI in critically ill patients.MethodsAll adult admissions to intensive care units (ICUs) in Korea from 2008 to 2015 were screened using the national health insurance review and assessment database, and 1,744,235 patients were included. Clinical characteristics and changes in AKI incidence and mortality rate were analyzed.ResultsThe incidence of AKI increased from 7.4% in 2008 to 8.3% in 2015 (p for trend < 0.001). Age-standardized AKI rate was 7018.6 per 100,000 person-years. In-hospital mortality significantly decreased from 39.1% in 2008 to 37.2% in 2015 (p for trend < 0.001) with 2427.6 deaths per 100,000 person-years. Patients with AKI showed higher in-hospital mortality, prolonged ICU length of stay, and higher total cost. Multivariable analysis showed increased risk of in-hospital mortality (adjusted odds ratio [OR] 3.74), mechanical ventilation (OR 2.87), ECMO (OR 6.99), and vasopressor requirement (OR 2.75) in patients with AKI.ConclusionsRecent advances in medical management for AKI have improved in-hospital mortality of critically ill patients with AKI despite increases in the elderly population and AKI incidence.
Highlights
No specific treatment facilitates renal tubular regeneration in acute kidney injury (AKI), the rapid increase in aging populations with more comorbidities and advances in critical care management are expected to change the epidemiology of AKI
A multinational prospective intensive care unit (ICU)-based study among 1802 patients reported that AKI severity was associated with mortality [8], and Kashani et al [9] reported that AKI incidence remained relatively stable after adjusting for age and gender in one county in the USA between 2006 and 2014
Overall in-hospital mortality rate of ICU patients was 12.1%, and the in-hospital mortality of AKI patients was higher compared to patients without AKI
Summary
No specific treatment facilitates renal tubular regeneration in acute kidney injury (AKI), the rapid increase in aging populations with more comorbidities and advances in critical care management are expected to change the epidemiology of AKI. Few recent studies dissected the current epidemiologic characteristics of critically ill patients with AKI. A multinational prospective intensive care unit (ICU)-based study among 1802 patients reported that AKI severity was associated with mortality [8], and Kashani et al [9] reported that AKI incidence remained relatively stable after adjusting for age and gender in one county in the USA between 2006 and 2014. Well-organized analyses of epidemiological changes of AKI such as incidence and mortality rates over time in large ICU populations and medical interventions may help optimize AKI public health policy and management
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