| 제목 | Changes in acute kidney injury epidemiology in critically ill patients: a population-based cohort study in Korea. | ||
|---|---|---|---|
| 작성자 | 관리자 | 등록일 | 2019-11-26 |
내용
Ann Intensive Care. 2019 Jun 7;9(1):65. doi: 10.1186/s13613-019-0534-7.
Changes in acute kidney injury epidemiology in critically ill patients: a population-based cohort study in Korea.
Hwang S1, Park H2, Kim Y2, Kang D2,3, Ku HS1, Cho J2,3, Lee JE4, Huh W4, Guallar E2,5, Suh GY6,7, Jang HR8.
Author information
- 1
- Department of Internal Medicine, Seoul Paik Hospital, Inje University School of Medicine, Seoul, Republic of Korea.
- 2
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- 3
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- 4
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- 5
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- 6
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. gy.suh@samsung.com.
- 7
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. gy.suh@samsung.com.
- 8
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. shinehr@skku.edu.
Abstract
BACKGROUND:
Although no specific treatment facilitates renal tubular regeneration in acute kidney injury (AKI), the rapid increase in aging populations with more comorbidities and advances in critical care management are expected to change the epidemiology of AKI. However, few recent studies dissected the current epidemiologic characteristics of critically ill patients with AKI. We investigated recent epidemiologic changes in severe AKI in critically ill patients.
METHODS:
All adult admissions to intensive care units (ICUs) in Korea from 2008 to 2015 were screened using the national health insurance review and assessment database, and 1,744,235 patients were included. Clinical characteristics and changes in AKI incidence and mortality rate were analyzed.
RESULTS:
The incidence of AKI increased from 7.4% in 2008 to 8.3% in 2015 (p for trend < 0.001). Age-standardized AKI rate was 7018.6 per 100,000 person-years. In-hospital mortality significantly decreased from 39.1% in 2008 to 37.2% in 2015 (p for trend < 0.001) with 2427.6 deaths per 100,000 person-years. Patients with AKI showed higher in-hospital mortality, prolonged ICU length of stay, and higher total cost. Multivariable analysis showed increased risk of in-hospital mortality (adjusted odds ratio [OR] 3.74), mechanical ventilation (OR 2.87), ECMO (OR 6.99), and vasopressor requirement (OR 2.75) in patients with AKI.
CONCLUSIONS:
Recent advances in medical management for AKI have improved in-hospital mortality of critically ill patients with AKI despite increases in the elderly population and AKI incidence.
KEYWORDS:
Acute kidney injury; Critically ill patients; Intensive care unit; Mortality
