Nephrology-Dialysis-Apheresis Unit, Nîmes University Hospital, Nimes, France.
UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, University of Montpellier, Montpellier, France.
PLoS One. 2019 Feb 7;14(2):e0211541. doi: 10.1371/journal.pone.0211541. eCollection 2019.
Acute kidney injury requiring dialysis (AKI-D) is associated with high mortality. Information about its epidemiology is nonetheless sparse in some countries. The objective of this study was to assess its epidemiology and prognosis in metropolitan France.
Using the French hospital discharge database, the study focused on adults hospitalized in metropolitan France between 2009 and 2014 and diagnosed with AKI-D according to the codes of the French common classification of medical procedures. Crude and standardized incidence rates (SIR) by gender and age were calculated. We explored the changes in patients' characteristics, modalities of renal replacement therapy (RRT), in-hospital care, and mortality, along with their determinants. Trends over time in the SIR for AKI-D, its principal diagnoses, and comorbidities were analyzed with joinpoint models.
Between 2009 and 2014, the AKI-D SIR increased from 475 (95% CI, 468 to 482) to 512 per million population (95% CI, 505 to 519). AKI-D was twice as high in men as women. Median age was 68 years. Over the study period, the AKI-D SIR steadily increased in all age groups, particularly in the elderly. The most common comorbidities were cardio-cerebrovascular diseases (64.8%), pulmonary disease (42.2%), CKD (33.8%), and diabetes (26.0%); all of these except CKD increased significantly over time. In 2009, heart failure (17.2%), sepsis (17.0%), AKI (13.0%), digestive diseases (10.7%), and shock (6.6%) were the most frequent principal diagnoses, with a significant increase in heart failure and digestive diseases. The proportion of patients with at least one ICU stay and continuous RRT increased from 80.3% to 83.9% and from 56.9% to 61.8% (p<0.001), respectively. In-hospital mortality was high but stable (47%) and higher in patients with an ICU stay.
This is the first exhaustive study in metropolitan France of the SIR for AKI-D. It shows this SIR has increased significantly over 6 years, together with ICU care and continuous RRT. In-hospital mortality is high but stable.
需要透析的急性肾损伤（AKI-D）与高死亡率相关。然而，在一些国家，有关其流行病学的信息仍然很缺乏。本研究的目的是评估法国大都市地区 AKI-D 的流行病学和预后。
利用法国住院数据库，本研究聚焦于 2009 年至 2014 年间在法国大都市地区住院的成年人，根据法国常见医疗程序分类的代码诊断为 AKI-D。按性别和年龄计算粗发病率和标准化发病率（SIR）。我们探讨了患者特征、肾脏替代治疗（RRT）方式、住院治疗和死亡率的变化及其决定因素。使用 joinpoint 模型分析 AKI-D、其主要诊断和合并症的 SIR 随时间的变化趋势。
2009 年至 2014 年间，AKI-D 的 SIR 从 475（95%CI，468 至 482）增加至 512/百万人口（95%CI，505 至 519）。男性 AKI-D 的发病率是女性的两倍。中位年龄为 68 岁。在研究期间，所有年龄段的 AKI-D SIR 均稳步上升，尤其是老年人。最常见的合并症是心脑血管疾病（64.8%）、肺部疾病（42.2%）、慢性肾脏病（33.8%）和糖尿病（26.0%）；除慢性肾脏病外，所有这些合并症的发病率均随时间显著增加。2009 年，心力衰竭（17.2%）、败血症（17.0%）、急性肾损伤（13.0%）、消化系统疾病（10.7%）和休克（6.6%）是最常见的主要诊断，心力衰竭和消化系统疾病的发病率显著增加。至少有一次 ICU 入住和持续 RRT 的患者比例分别从 80.3%增加至 83.9%，从 56.9%增加至 61.8%（p<0.001）。住院死亡率较高但稳定（47%），且 ICU 入住患者的死亡率更高。
这是法国大都市地区首次对 AKI-D 的 SIR 进行的全面研究。研究表明，6 年来 SIR 显著增加，同时 ICU 护理和持续 RRT 也增加。住院死亡率较高但稳定。
