Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Abstract

Backgrounds. There are no national level data on types of dialysis in use for acute kidney injury (AKI). We aimed to assess trends in dialysis modality for AKI and mortality associated with each modality from 1998 to 2005. Methods. Using data from the 5% Medicare cohort, we identified individuals with AKI requiring dialysis. Individuals with preexisting end-stage renal disease were excluded. Intermittent hemodialysis (IHD), daily intermittent hemodialysis, and continuous renal replacement therapy (CRRT) were defined using Current Procedure Terminology codes. Mortality was defined as death during 30 days after the first dialysis session. Results. Between 1998 and 2005, there were a total of 18,249 patients identified with AKI requiring renal replacement therapy. CRRT was increasingly used for AKI, with 9.9% of patients in 1998 to 18.3% by 2005. Proportion of daily dialysis decreased during this period, while use of IHD remained stable at approximately 68%. Overall 30-day mortality declined from 44.4% in 1998 to 40.2% in 2005.Crude mortality for CRRT was highest in all years (51.0-61.8%), followed by daily (38.2-49.9%) and IHD groups (35.8-43.4%). Multinomial logistic regression analysis showed that white race, presence of sepsis, atherosclerotic heart diseases, peripheral vascular diseases, dysrhythmia, gastrointestinal and liver diseases, and any year after 2000 were independently associated with higher odds of using CRRT after adjusting for other variables. Conclusion. The proportion of patients using CRRT has increased over time. Mortality associated with IHD has decreased from 1998 to 2005. Mortality associated with different dialysis modalities is likely the result of severity of illness.

Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors—A Nationwide Study

“…Although prevalence of hypertension and diabetes increased, prevalence of peripheral vascular disease and ischemic heart disease decrease. However, although not unambiguous, similar patterns have been observed in other dialysis-requiring AKI populations [ 24 , 40 ]. As such, the observed growth and stabilization of incident dialysis-requiring AKI could be representative of a general change in clinical paradigm, rather than genuine growth in dialysis-requiring AKI.…”

“…Plausibly due to the influx in use of CRRT, dialysis-requiring AKI was increasingly associated with non-renal organ failure. Throughout the last decade an ever greater proportion of patients with dialysis-requiring AKI initiate treatment with CRRT in the intensive care unit [ 24 , 40 ]. Possibly due the increasing burden of circulatory failure [ 41 , 42 ], and the increase in concurrent respiratory failure [ 6 , 24 , 42 , 43 ].…”

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

“…In aggregate, these data suggest that when AKI complicates MI, there is significant long-term risk for the development of cardiorenal syndrome (35). In general, administrative database studies rarely have adequate granularity to account for all the possible aspects that influence outcome (4,8,(36)(37)(38)(39). These types of studies are valuable for hypothesis generation and revealing important associations.…”

Continuous Renal Replacement Therapies: Raising the Bar for Quality Care

“…Hildy Schell-Chaple, RN, PhD, CCRN, CCNS Symposium Editor C ontinuous renal replacement therapy (CRRT) has become a standard therapy option and has been widely used for critically ill patients requiring renal support since it was introduced 4 decades ago. [1][2][3][4] Patients requiring CRRT are typically at high risk of death related to their severity of illness, and mortality rates in this population have remained steady around 50% since the advent of CRRT. [5][6][7][8] The advances in CRRT hemofilter supplies and device technologies in the past 2 decades aimed to improve safety and quality in delivery of this therapy.…”