Temporal change in characteristics and outcomes of acute kidney injury on renal replacement therapy in intensive care units: analysis of a nationwide administrative database in Japan, 2007–2016

Abstract

Background We aimed to examine recent trends in patient characteristics and mortality in patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT), including continuous RRT (CRRT) and intermittent RRT (IRRT), in intensive care units (ICUs). Methods From the Diagnosis Procedure Combination database in Japan during 6 months (July–December) from 2007 to 2016, we identified patients with AKI who received RRT in ICUs. We restricted the study participants to those admitted to hospitals (in which both CRRT and IRRT were available) that participated in the Diagnosis Procedure Combination database for all 10 years. We examined the trends in patient characteristics and mortality overall, by RRT modality, and by main diagnosis category subgroup. Logistic regression was used to adjust for patient characteristics. Results We identified 51,758 patients starting RRT in 287 hospitals, including 39,471 (76.3%) and 12,287 (23.7%) patients starting CRRT and IRRT. The crude in-hospital mortality declined from 44.9 to 36.1% ( P for trend < 0.001). Compared with 2007, the adjusted odds ratio (aOR) for in-hospital mortality was 0.66 (95% confidence interval (CI) 0.60–0.72) in 2016, and the decreasing trend was observed in both patients starting CRRT (aOR 0.67, 95% CI 0.61–0.75) and IRRT (0.58, 0.45–0.74), and in all subgroups except for coronary artery disease: sepsis aOR 0.68 (95% CI 0.57–0.81); cardiovascular surgery 0.58 (0.45–0.76); coronary artery disease 0.84 (0.60–1.19); non-coronary heart disease 0.78 (0.64–0.94); central nervous system disorders 0.42 (0.28–0.62); trauma 0.39 (0.21–0.72); and other 0.64 (0.50–0.82). Conclusions This nationwide study confirmed a consistent decline in mortality among patients with AKI on RRT in ICUs. The adjusted mortality also declined during the study period; however, physiological variables were not measured in this study and it is possible that RRT may have been indicated for patients with less severe AKI in more recent years. Electronic supplementary material The online version of this article (10.1186/s13054-019-2468-8) contains supplementary material, which is available to authorized users.

Continuous renal replacement therapy in elderly with acute kidney injury

“…Medina-Liabres KRP and Kim S. CRRT in the elderly to 68.7 years over a 10-year period (p for trend < 0.01) [7].…”

Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest

“…In case of critically ill patients, the overall in-hospital mortality in patients with AKI on dialysis consistently decreased, and the mortality of those with AKI on dialysis was relatively lower than that of the RRT group with OHCA; this is because outcomes associated with OHCA remain poor [18].…”

The need for disruptive innovation in acute kidney injury

“…As previously described, uremic conditions can be controlled through advanced technique of RRT even in unstable patients. In spite of the prevalence of technical advances, poor outcomes of AKI-D have been reported worldwide [66,67,80,81]. These data indicate the following possibilities: (1) still insufficient replacement of renal function by current RRT, (2) considerably higher impact of other organ injuries on mortality than AKI, and (3) unrecognized mechanisms such as amplification of distant organ injury by AKI (organ crosstalk).…”

“…Data obtained from the Japanese Diagnosis Procedure Combination database in 2011 showed that approximately 80% of adult dialysis-requiring AKI (AKI-D) patients in ICUs initially received CRRT [ 65 ]. Unfortunately, the mortality rate of AKI-D patients was unacceptably high (40–50%), although it gradually decreased in the last decades [ 66 , 67 ]. Similar finding of gradual mortality reduction was reported in all the AKI population, whose mortality was approximately 20–30% [ 68 ].…”