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

Abstract

Background 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 traumatic and non-traumatic AKI requiring renal replacement therapy (AKI-RRT). Methods This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Vehicle-trauma patients developing AKI-RRT during hospitalization were identified, and matching non-traumatic AKI-RRT patients were identified between 2000 and 2010. The incidences of end-stage kidney disease (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. Results 546 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, 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. Traumatic AKI-RRT patients had lower rates of long-term mortality (adjusted hazard ratio (HR), 0.488; 95% CI, 0.405-0.588; p < 0.001), but similar rates of ESKD (HR, 1.075; 95% CI, 0.767–1.509; p = 0.674) and short-term risk of death (HR, 1.165; 95% CI, 0.920-1.476; p = 0.205) as non-traumatic AKI-RRT patients. Conclusions Despite severe injuries, 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 traumatic AKI-RRT.