The Impact of Dialysis-Requiring Acute Kidney Injury on Long-Term Prognosis of Patients Requiring Prolonged Mechanical Ventilation: Nationwide Population-Based Study

Abstract

BackgroundProlonged mechanical ventilation (PMV) is increasingly common worldwide, consuming enormous healthcare resources. Factors that modify PMV outcome are still obscure.MethodsWe selected patients without preceding mechanical ventilation within the one past year and who developed PMV during index admission in Taiwan's National Health Insurance (NHI) system during 1998–2007 for comparison of mortality and resource use. They were divided into three groups: (1) patients with end-stage renal diseases (ESRD) before the index admission for PMV onset; (2) patients with dialysis-requiring acute kidney injury (AKI-dialysis) during the hospitalization course; and (3) patients without AKI or with non dialysis-requiring AKI during the hospitalization course (non-AKI). We used a random-effects logistic regression model to identify factors associated with mortality.ResultsCompared with the other two groups, patients with AKI-dialysis had significantly longer mechanical ventilation, more frequent use of vasopressors, longer intensive care unit/hospital stay and higher inpatient expenditures during the index admission. Relative to non-AKI patients, patients with AKI-dialysis had an elevated mortality hazard; the adjusted relative risk ratios were 1.51 (95% confidence interval [CI]:1.46–1.56), 1.27 (95% CI: 1.23–1.32), and 1.10 (95% CI: 1.08–1.12) for mortality rates at discharge, 3 months, and 4 years after PMV, respectively. Patients with AKI-dialysis also consumed significantly higher total in-patient expenditure than the other two patient groups (p<0.001).ConclusionsAmong patients that need PMV care during an admission, the presence of de novo AKI requiring dialysis significantly increased short and long term mortality, and demand for health care resources.

Impact of Body Mass on Outcomes of Geriatric Postoperative Acute Kidney Injury Patients

“…Being underweight signifies the loss of limb/respiratory muscles (sarcopenia) and probably malnutrition, resulting in susceptibility to pneumonia with respiratory failure and immunodeficiency (32,33). In addition, weight loss also compromises the functional status of the elderly, contributing to frailty and poorer outcomes (34).…”

In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

“…Furthermore, older patients have more limited renal reserve and are prone to develop AKI [46], [47]. AKI impairs the survival of elderly in-patients by deranging the body fluid/electrolyte balance, and this impairment is expectedly exaggerated in the extremely old [48]–[50]. Consequently, nonagenarians with a main admission diagnosis of nephrologic diseases and AKI are at risk for adverse outcomes compared with other patients of similar age.…”

Long-Term Risk of Coronary Events after AKI

“…The NHI database is one of the largest and most comprehensive databases in the world, and it has been offering research data to various studies on prescription use, diagnoses, and hospitalizations. 33 The National Health Research Institutes used original data from the NHI database to construct a longitudinal database of patients who were ever admitted between 1999 and 2008. This cohort included 2,619,534 hospitalized patients, representing 10% of all NHI enrollees.…”

“…The dialysis certificate data in Taiwan are highly reliable, because they are used for insurance payment. 33 To identify the patients' baseline conditions, we used the 1-year period immediately before the index hospitalization to identify preadmission comorbidities, AKI, and dialysis. Patients with preadmission AKI or ESRD, MI, or cardiac revascularization were excluded as well as those patients who underwent kidney transplantation, vascular accesses creation, or peritoneal dialysis catheter implantation.…”