Abstract
BackgroundAcute kidney injury requiring dialysis (AKI-D) is associated with high mortality. Information about its epidemiology is nonetheless sparse in some countries. The objective of this study was to assess its epidemiology and prognosis in metropolitan France.MethodsUsing the French hospital discharge database, the study focused on adults hospitalized in metropolitan France between 2009 and 2014 and diagnosed with AKI-D according to the codes of the French common classification of medical procedures. Crude and standardized incidence rates (SIR) by gender and age were calculated. We explored the changes in patients’ characteristics, modalities of renal replacement therapy (RRT), in-hospital care, and mortality, along with their determinants. Trends over time in the SIR for AKI-D, its principal diagnoses, and comorbidities were analyzed with joinpoint models.ResultsBetween 2009 and 2014, the AKI-D SIR increased from 475 (95% CI, 468 to 482) to 512 per million population (95% CI, 505 to 519). AKI-D was twice as high in men as women. Median age was 68 years. Over the study period, the AKI-D SIR steadily increased in all age groups, particularly in the elderly. The most common comorbidities were cardio-cerebrovascular diseases (64.8%), pulmonary disease (42.2%), CKD (33.8%), and diabetes (26.0%); all of these except CKD increased significantly over time. In 2009, heart failure (17.2%), sepsis (17.0%), AKI (13.0%), digestive diseases (10.7%), and shock (6.6%) were the most frequent principal diagnoses, with a significant increase in heart failure and digestive diseases. The proportion of patients with at least one ICU stay and continuous RRT increased from 80.3% to 83.9% and from 56.9% to 61.8% (p<0.001), respectively. In-hospital mortality was high but stable (47%) and higher in patients with an ICU stay.ConclusionsThis is the first exhaustive study in metropolitan France of the SIR for AKI-D. It shows this SIR has increased significantly over 6 years, together with ICU care and continuous RRT. In-hospital mortality is high but stable.
Highlights
Acute kidney injury (AKI) is a common and severe complication in hospitalized patients [1,2]
Between 2009 and 2014, the AKI requiring dialysis (AKI-D) standardized incidence rates (SIR) increased from 475 to 512 per million population
The AKI-D SIR steadily increased in all age groups, in the elderly
Summary
Acute kidney injury (AKI) is a common and severe complication in hospitalized patients [1,2]. Remains insufficiently characterized in the absence of accurate reporting of this event in many countries. In England, Kolhe et al report that the CIR for AKI-D jumped from 15.9 to 208.7 pmp between 1998 and 2013 [8] These increased incidence rates may be attributable to the growth of either susceptibility risk factors, such as advanced age, chronic kidney disease (CKD), and diabetes, or of exposure risk factors, such as nephrotoxic drugs or agents, sepsis, critical illness, and major surgery, together with changes in clinical practice related to indications for renal replacement therapy (RRT) [7,8,11,12]. Acute kidney injury requiring dialysis (AKI-D) is associated with high mortality. The objective of this study was to assess its epidemiology and prognosis in metropolitan France
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
