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.