Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Division of Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Transplantation. 2019 Nov;103(11):2405-2412. doi: 10.1097/TP.0000000000002663.
The incidence of acute kidney injury (AKI) and AKI requiring dialysis (AKI-D) in the general population is increasing. However, there is limited information on the epidemiology of AKI-related hospitalizations in the prevalent US kidney transplant population.
We analyzed trends in the incidence of hospitalizations with primary diagnosis of AKI and secondary diagnosis of AKI and AKI-D using data from the National Inpatient Sample 2004-2014. Co-primary endpoints were in-hospital mortality, length of stay (LOS), and cost. Survey analysis techniques were used to compute national estimates. Linear trends in outcomes were evaluated using linear regression.
There were a total of 37 562 hospitalizations for primary AKI, 136 628 for secondary AKI, and 10 731 for AKI-D during the study period. We found an increase in hospitalizations for all 3 diagnoses over time (13.7-24.7 per thousand kidney transplant recipients [KTRs] for primary AKI, 37.4-108.0 per thousand KTRs for secondary AKI, and 4.2-6.0 per thousand KTRs for AKI-D; all P trend < 0.01). This was accompanied by significant improvements in in-hospital mortality (3.2%-0.5% for primary and 6.1%-4.4% for secondary AKI; both P trend < 0.01), average LOS (5.3-4.6 days for primary and 8.4-7.2 days for secondary AKI; both P trend < 0.001), and cost ($11 635-$8234 for primary and $21 373-$17 470 for secondary AKI; P trend < 0.001 for both).
The incidence of hospitalizations for AKI and AKI-D among KTRs is rapidly rising. This has been accompanied by significant improvements in in-hospital mortality, LOS, and cost.
普通人群中急性肾损伤（AKI）和需要透析的 AKI（AKI-D）的发病率正在上升。然而，在现有的美国肾移植人群中，关于 AKI 相关住院的流行病学信息有限。
我们使用 2004 年至 2014 年国家住院患者样本的数据，分析了主要诊断为 AKI 和次要诊断为 AKI 和 AKI-D 的住院人数的发病率趋势。主要终点是住院死亡率、住院时间（LOS）和费用。采用调查分析技术计算全国估计值。使用线性回归评估结果的线性趋势。
在研究期间，共有 37562 例 AKI 原发性住院，136628 例 AKI 继发性住院和 10731 例 AKI-D 住院。我们发现所有 3 种诊断的住院人数随时间增加（原发性 AKI 每千名肾移植受者为 13.7-24.7 例，继发性 AKI 为 37.4-108.0 例，AKI-D 为 4.2-6.0 例；所有 P 趋势 <0.01）。这伴随着住院死亡率的显著改善（原发性 AKI 为 3.2%-0.5%，继发性 AKI 为 6.1%-4.4%；两者均 P 趋势 <0.01），平均 LOS（原发性 AKI 为 5.3-4.6 天，继发性 AKI 为 8.4-7.2 天；两者均 P 趋势 <0.001）和费用（原发性 AKI 为 11635-8234 美元，继发性 AKI 为 21373-17470 美元；两者均 P 趋势 <0.001）。
肾移植受者 AKI 和 AKI-D 的住院人数迅速增加。这伴随着住院死亡率、LOS 和费用的显著改善。
