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

TY - JOUR

T1 - Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012

T2 - Time Trends of Incidence and Prevalence of Risk Factors - A Nationwide Study

AU - Carlson, Nicholas

AU - Hommel, Kristine

AU - Olesen, Jonas Bjerring

AU - Soja, Anne Merete Boas

AU - Lauritsen, Tina Vilsbøll

AU - Kamper, Anne-Lise

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

PY - 2016/2

Y1 - 2016/2

N2 - INTRODUCTION: Dialysis-requiring acute kidney injury is a severe illness associated with poor prognosis. However, information pertaining to incidence rates and prevalence of risk factors remains limited in spite of increasing focus. We evaluate time trends of incidence rates and changing patterns in prevalence of comorbidities, concurrent medication, and other risk factors in nationwide retrospective cohort study.MATERIALS AND METHODS: All patients with dialysis-requiring acute kidney injury were identified between January 1st 2000 and December 31st 2012. By cross-referencing data from national administrative registries, the association of changing patterns in dialysis treatment, comorbidity, concurrent medication and demographics with incidence of dialysis-requiring acute kidney injury was evaluated.RESULTS: A total of 18,561 adult patients with dialysis-requiring AKI were identified between 2000 and 2012. Crude incidence rate of dialysis-requiring AKI increased from 143 per million (95% confidence interval, 137-144) in 2000 to 366 per million (357-375) in 2006, and remained stable hereafter. Notably, incidence of continuous veno-venous hemodialysis (CRRT) and use of acute renal replacement therapy in elderly >75 years increased substantially from 23 per million (20-26) and 328 per million (300-355) in 2000, to 213 per million (206-220) and 1124 per million (1076-1172) in 2012, respectively. Simultaneously, patient characteristics and demographics shifted towards increased age and comorbidity.CONCLUSIONS: Although growth in crude incidence rate of dialysis-requiring AKI stabilized in 2006, continuous growth in use of CRRT, and acute renal replacement therapy of elderly patients >75 years, was observed. Our results indicate an underlying shift in clinical paradigm, as opposed to unadulterated growth in incidence of dialysis-requiring AKI.

AB - INTRODUCTION: Dialysis-requiring acute kidney injury is a severe illness associated with poor prognosis. However, information pertaining to incidence rates and prevalence of risk factors remains limited in spite of increasing focus. We evaluate time trends of incidence rates and changing patterns in prevalence of comorbidities, concurrent medication, and other risk factors in nationwide retrospective cohort study.MATERIALS AND METHODS: All patients with dialysis-requiring acute kidney injury were identified between January 1st 2000 and December 31st 2012. By cross-referencing data from national administrative registries, the association of changing patterns in dialysis treatment, comorbidity, concurrent medication and demographics with incidence of dialysis-requiring acute kidney injury was evaluated.RESULTS: A total of 18,561 adult patients with dialysis-requiring AKI were identified between 2000 and 2012. Crude incidence rate of dialysis-requiring AKI increased from 143 per million (95% confidence interval, 137-144) in 2000 to 366 per million (357-375) in 2006, and remained stable hereafter. Notably, incidence of continuous veno-venous hemodialysis (CRRT) and use of acute renal replacement therapy in elderly >75 years increased substantially from 23 per million (20-26) and 328 per million (300-355) in 2000, to 213 per million (206-220) and 1124 per million (1076-1172) in 2012, respectively. Simultaneously, patient characteristics and demographics shifted towards increased age and comorbidity.CONCLUSIONS: Although growth in crude incidence rate of dialysis-requiring AKI stabilized in 2006, continuous growth in use of CRRT, and acute renal replacement therapy of elderly patients >75 years, was observed. Our results indicate an underlying shift in clinical paradigm, as opposed to unadulterated growth in incidence of dialysis-requiring AKI.

KW - Acute Kidney Injury

KW - Aged

KW - Aged, 80 and over

KW - Cardiovascular Diseases

KW - Cohort Studies

KW - Comorbidity

KW - Denmark

KW - Diabetes Mellitus

KW - Drug Utilization

KW - Female

KW - Humans

KW - Incidence

KW - Liver Diseases

KW - Male

KW - Middle Aged

KW - Morbidity

KW - Neoplasms

KW - Prevalence

KW - Pulmonary Disease, Chronic Obstructive

KW - Registries

KW - Renal Dialysis

KW - Retrospective Studies

KW - Risk Factors

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1371/journal.pone.0148809

DO - 10.1371/journal.pone.0148809

M3 - Journal article

C2 - 26863015

SN - 1932-6203

VL - 11

SP - 1

EP - 14

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 2

M1 - e0148809

ER -