Hospital case volume and clinical outcomes in critically ill patients with acute kidney injury treated with dialysis

Chimunda, Timothy; Silver, Samuel A.; Kuwornu, John Paul; Li, Lihua; Nash, Danielle M.; Dixon, Stephanie N.; Adhikari, Neill K. J.; Acedillo, Rey; Harel, Ziv; Kitchlu, Abhijat; Garg, Amit X.; Bell, Chaim M.; Sood, Manish M.; Kim, Joseph S; Wald, Ron

doi:10.1016/j.jcrc.2018.08.024

Cited by 5 publications

(7 citation statements)

References 26 publications

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“…Further investigation on the generalizability of the inverse association between AKI incidence and the AKI-attributable fraction of mortality is needed. Since a previous report denied the effect of hospital case volume on patients with AKI treated with dialysis [25], the favorable effect of higher AKI incidence determined by our study may occur specifically among nondialysis AKI patients. Moreover, it was noted that similar analysis of total pediatric AKI cohorts did not show significant trends, probably due to a limited number of reports and different clinical settings.…”

Section: Discussion/conclusionmentioning

confidence: 59%

Correlation between the Incidence and Attributable Mortality Fraction of Acute Kidney Injury: A Systematic Review

et al. 2020

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Introduction: The incidence of acute kidney injury (AKI) as diagnosed by international standardized criteria as well as its mortality has undergone extreme variations. Although AKI is a significant worsening mortality factor, a higher prevalence may lead to better patient management, thereby lowering mortality. We investigated the correlation between AKI incidence and its associated mortality. Methods: We conducted a systematic review of studies on AKI reporting its incidence and mortality. Literature searches were performed in MEDLINE, EMBASE, and Cochrane Library, within the time frame of 2004-2018. Studies with small number of participants (< 500 for adult cohorts, 50 for pediatric cohorts) were excluded. The correlation among AKI incidence, mortality, and AKI-attributable fraction of mortality was evaluated using a regression model. The trend test was used to analyze the effect of publication year and country gross domestic product (GDP). Results: A total of 4,694 manuscripts were screened, from which 287 cohorts were eligible (adults: 203 cohorts comprising 7,076,459 patients; children: 84 comprising 69,677 patients). Within adult cohorts, AKI patients' mortality increased (R 2 = 0.023, β = 0.12, p = 0.03) but the attributable fraction of mortality decreased (R 2 = 0.27, β =-0.43, p < 0.001) with the increasing AKI incidence. Both more recent publications and higher GDP countries had a lower crude AKI patients' mortality, although AKI-attributable fraction did not decrease. Conclusions: Cohorts with high AKI incidence had a relatively low AKI-attributable mortality fraction, which suggests an advantage of more experienced AKI management. Further study is needed, however, to address the heterogeneity of included cohorts and to confirm the causality. (Registered in prospective register of systematic reviews database; CRD 42019129322.)

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Section: Discussion/conclusionmentioning

confidence: 59%

Correlation between the Incidence and Attributable Mortality Fraction of Acute Kidney Injury: A Systematic Review

et al. 2020

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“…For example, studies have demonstrated the beneficial effects of being admitted to an ICU with mandatory staffing (or consultation) by intensivists. 36 The importance of experience is highlighted by studies revealing a "volume-outcome relationship" for mechanically ventilated patients 37 and patients receiving RRT, [38][39][40] where patients who receive these interventions have better outcomes if admitted to hospitals that care for a larger number of such patients. When analyzing rates of renal recovery among patients with AKI-RRT who survived to hospital discharge, we found that .30% remained RRT dependent on discharge.…”

Section: Discussionmentioning

confidence: 99%

AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19

Gupta¹,

Coca²,

Chan³

et al. 2020

JASN

250

254

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BackgroundAKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT).MethodsWe conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients.ResultsA total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1–123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission.ConclusionsAKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.

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Section: Short-term Outcomesmentioning

confidence: 96%

“…An Italian study showed in-hospital mortality rate of nearly 30% with the highest risk being in patients with AKI receiving KRT [odds ratio, 2.7; 95% confidence interval (CI), 2.7–2.8] ( 72 ). Finally, another Canadian study showed mortality rates between 30 and 40% for adult patients with AKI receiving KRT, but no association with increased mortality in centers who manage a lower volume of patients requiring KRT ( 73 ). The Canadian study in children with AKI receiving KRT also examined 30-day mortality, finding an increased rate from 14 to 25% between 1996 and 2009, although this rate subsequently decreased to 19% by 2015 ( 69 ).…”

Section: Epidemiology and Outcomes Of Akimentioning

confidence: 99%

A Review on the Application and Limitations of Administrative Health Care Data for the Study of Acute Kidney Injury Epidemiology and Outcomes in Children

Ulrich

Zappitelli

et al. 2021

Front. Pediatr.

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Administrative health care databases contain valuable patient information generated by health care encounters. These “big data” repositories have been increasingly used in epidemiological health research internationally in recent years as they are easily accessible and cost-efficient and cover large populations for long periods. Despite these beneficial characteristics, it is also important to consider the limitations that administrative health research presents, such as issues related to data incompleteness and the limited sensitivity of the variables. These barriers potentially lead to unwanted biases and pose threats to the validity of the research being conducted. In this review, we discuss the effectiveness of health administrative data in understanding the epidemiology of and outcomes after acute kidney injury (AKI) among adults and children. In addition, we describe various validation studies of AKI diagnostic or procedural codes among adults and children. These studies reveal challenges of AKI research using administrative data and the lack of this type of research in children and other subpopulations. Additional pediatric-specific validation studies of administrative health data are needed to promote higher volume and increased validity of this type of research in pediatric AKI, to elucidate the large-scale epidemiology and patient and health systems impacts of AKI in children, and to devise and monitor programs to improve clinical outcomes and process of care.

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Hospital case volume and clinical outcomes in critically ill patients with acute kidney injury treated with dialysis

Cited by 5 publications

References 26 publications

Correlation between the Incidence and Attributable Mortality Fraction of Acute Kidney Injury: A Systematic Review

Correlation between the Incidence and Attributable Mortality Fraction of Acute Kidney Injury: A Systematic Review

AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19

A Review on the Application and Limitations of Administrative Health Care Data for the Study of Acute Kidney Injury Epidemiology and Outcomes in Children

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