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Acute Kidney Injury Requiring Dialysis in Severe Sepsis.
Am J Respir Crit Care Med. 2015 Jun 29;
Authors: Sakhuja A, Kumar G, Gupta S, Mittal T, Taneja A, Nanchal RS
Abstract
RATIONALE: Understanding the changing incidence and impact of acute kidney injury requiring dialysis in patients with severe sepsis will allow better risk stratification, design of clinical trials and guide resource allocation.
OBJECTIVES: To assess the longitudinal incidence of acute kidney injury requiring dialysis and its impact on mortality in patients with severe sepsis.
METHODS: Retrospective, cohort study of adults (≥20 years) hospitalized with severe sepsis from 2000-2009 in United States using a nationally representative database.
MEASUREMENTS: We calculated the incidences of acute kidney injury requiring dialysis and mortality over time. We used linear regression to assess temporal trends. We used logistic regression to estimate the odds of acute kidney injury requiring dialysis and mortality.
MAIN RESULTS: Of the estimated 5,257,907 hospitalizations with severe sepsis, 6.1% had acute kidney injury requiring dialysis. The odds of acquiring acute kidney injury requiring dialysis increased by 14% in 2009 compared to 2000. Mortality in patients with acute kidney injury requiring dialysis was higher (43.6% versus 24.9%; p<0.001). After multivariable adjustment, odds of mortality declined 61% by the year 2009. Acute kidney injury requiring dialysis remained an independent predictor of mortality in patients with severe sepsis, though its influence of mortality declined with time.
CONCLUSIONS: Incidence of acute kidney injury requiring dialysis in patients with severe sepsis has increased over time, conversely associated mortality has declined. The likelihood of demise from acute kidney injury requiring dialysis in patients with severe sepsis has also declined.
PMID: 26120892 [PubMed - as supplied by publisher]