Long-term outcomes following vehicle trauma related acute kidney injury requiring renal replacement therapy: a nationwide population study

Chieh-Kai Chan,Nai-Kuan Chou,Vin-Cent Wu,Tao-Min Huang,John R Prowle,Yung-Ming Chen,Yi-Ping Huang,Chun-Yi Chi,Tai-Shuan Lai

doi:10.1038/s41598-020-77556-3

Abstract

Acute kidney injury (AKI) is a frequent complication of traumatic injury; however, long-term outcomes such as mortality and end-stage kidney disease (ESKD) have been rarely reported in this important patient population. We compared the long-term outcome of vehicle-traumatic and non-traumatic AKI requiring renal replacement therapy (AKI-RRT). This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Vehicle-trauma patients who were suffered from vehicle accidents developing AKI-RRT during hospitalization were identified, and matching non-traumatic AKI-RRT patients were identified between 2000 and 2010. The incidences of ESKD, 30-day, and long-term mortality were evaluated, and clinical and demographic associations with these outcomes were identified using Cox proportional hazards regression models. 546 vehicle-traumatic AKI-RRT patients, median age 47.6 years (interquartile range: 29.0–64.3) and 76.4% male, were identified. Compared to non-traumatic AKI-RRT, vehicle-traumatic AKI-RRT patients had longer length of stay in hospital [median (IQR):15 (5–34) days vs. 6 (3–11) days; p < 0.001). After propensity matching with non-traumatic AKI-RRT cases with similar demographic and clinical characteristics. Vehicle-traumatic AKI-RRT patients had lower rates of long-term mortality (adjusted hazard ratio (HR), 0.473; 95% CI, 0.392–0.571; p < 0.001), but similar rates of ESKD (HR, 1.166; 95% CI, 0.829–1.638; p = 0.377) and short-term risk of death (HR, 1.134; 95% CI, 0.894–1.438; p = 0.301) as non-traumatic AKI-RRT patients. In competing risk models that focused on ESKD, vehicle-traumatic AKI-RRT patients were associated with lower ESKD rates (HR, 0.552; 95% CI, 0.325–0.937; p = 0.028) than non-traumatic AKI-RRT patients. Despite severe injuries, vehicle-traumatic AKI-RRT patients had better long-term survival than non-traumatic AKI-RRT patients, but a similar risk of ESKD. Our results provide a better understanding of long-term outcomes after vehicle-traumatic AKI-RRT.

Highlights

Acute kidney injury (AKI) has been studied in a wide range of populations and has been consistently associated with increased risk of future morbidity and mortality[1,2]
The in-hospital mortality associated with AKI ranges from 9.1% to 21.9% in the United S tates[3], and amounts to as high as 62% in the critical care setting in patients requiring renal replacement therapy (RRT)[4,5]
Among 123,470 hospitalized AKI-RRT patients in the past decade, we identified 546 vehicle-traumatic AKI-RRT patients who survived to index discharge (Fig. 1)

Summary

Introduction

Acute kidney injury (AKI) has been studied in a wide range of populations and has been consistently associated with increased risk of future morbidity and mortality[1,2]. The in-hospital mortality associated with AKI ranges from 9.1% to 21.9% in the United S tates[3], and amounts to as high as 62% in the critical care setting in patients requiring renal replacement therapy (RRT)[4,5]. As AKI is a clinical syndrome it treatment should be tailored to its underlying etiology. Acute dialysis during admission from 2000 to 2010 (N=159,557). Excluded (N=36,087) Age100 years (N=2,087) Having prior history of dialysis or dialysis access creaƟon (N=27,196) Having prior history of kidney transplant (N=525) Mortality during hospitalizaƟon (N=6,279). IdenƟfied paƟents with AKI and renal replacement therapy (N=123,470).

Methods

Results

Conclusion