Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia. Email:
Department of Nephrology, Division of Medicine, Royal Darwin Hospital, PO Box 41326, Casuarina, NT 0811, Australia. Email:
Aust Health Rev. 2020 Apr;44(2):234-240. doi: 10.1071/AH18230.
Objective The Northern Territory has the highest incidence of haemodialysis care for end-stage kidney disease in Australia. Although acute kidney injury (AKI) is a recognised risk for chronic kidney disease (CKD), the effect of AKI causing incident haemodialysis (iHD) is unknown. Audits identifying antecedents of iHD may inform health service planning. Thus, the aims of this study were to describe: (1) the development of an iHD recording system involving patients with AKI and CKD; and (2) the incidence, patient characteristics and mortality for patients with dialysis-requiring AKI. Methods A retrospective data linkage study was conducted using eight clinical and administrative datasets of adults receiving iHD during the period from July 2011 to December 2012 within a major northern Australian hospital for AKI without CKD (AKI), AKI in people with pre-existing CKD (AKI/CKD) and CKD (without AKI). The time to death was identified by the Northern Territory Register of deaths. Results In all, 121 iHD treatments were provided for the cohort, whose mean age was 51.5 years with 53.7% female, 68.6% Aboriginal ethnicity and 46.3% with diabetes. iHD was provided for AKI (23.1%), AKI/CKD (47.1%) and CKD (29.8%). The 90-day mortality rate was 25.6% (AKI 39.3%, AKI/CKD 22.8%, CKD 19.4%). The 3-year mortality rate was 45.5% (AKI 53.6%, AKI/CKD 22.8%, CKD 19.4%). The time between requesting data from custodians and receipt of data ranged from 15 to 1046 days. Conclusion AKI in people with pre-existing CKD was a common cause of iHD. Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis. What is known about the topic? AKI is a risk factor for CKD. The Northern Territory has the highest national incidence rates of dialysis-dependent end-stage kidney disease, but has no audit tool describing outcomes of dialysis-requiring AKI. What does this paper add? We audited all iHD and showed 25.6% mortality within the first 90 days of iHD and 45.5% overall mortality at 3 years. AKI in people with pre-existing CKD caused 47.1% of iHD. What are the implications for practitioners? Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis.
目的
北领地是澳大利亚终末期肾病血液透析治疗发病率最高的地区。尽管急性肾损伤 (AKI) 是慢性肾脏病 (CKD) 的一个公认风险，但 AKI 导致新发血液透析 (iHD) 的影响尚不清楚。识别 iHD 发病前的情况可能有助于卫生服务规划。因此，本研究的目的是描述：(1) 开发一个涉及 AKI 和 CKD 患者的 iHD 记录系统；(2) 透析依赖型 AKI 的发病率、患者特征和死亡率。
方法
采用回顾性数据链接研究，使用 8 个临床和行政数据集，对 2011 年 7 月至 2012 年 12 月期间在澳大利亚北部一家主要医院接受 iHD 的 AKI 无 CKD (AKI)、AKI 合并预先存在 CKD (AKI/CKD) 和 CKD (无 AKI) 的患者进行研究。通过北领地死亡登记册确定死亡时间。
结果
共为该队列提供了 121 次 iHD 治疗，患者平均年龄为 51.5 岁，女性占 53.7%，土著民族占 68.6%，糖尿病占 46.3%。iHD 用于 AKI(23.1%)、AKI/CKD(47.1%)和 CKD(29.8%)。90 天死亡率为 25.6%(AKI 为 39.3%，AKI/CKD 为 22.8%，CKD 为 19.4%)。3 年死亡率为 45.5%(AKI 为 53.6%，AKI/CKD 为 22.8%，CKD 为 19.4%)。从托管人处请求数据到收到数据的时间范围为 15 至 1046 天。
结论
预先存在 CKD 的 AKI 是 iHD 的常见原因。卫生服务规划和社区卫生可能受益于 AKI 预防策略的实施，以及与用于监测前瞻性 iHD 的数据集建立可持续和永久的联系。
关于该主题已知的内容？
AKI 是 CKD 的一个风险因素。北领地的透析依赖性终末期肾病发病率在全国最高，但尚无用于描述透析依赖型 AKI 结果的审计工具。
本文添加了什么内容？
我们对所有 iHD 进行了审核，结果显示，iHD 后 90 天内死亡率为 25.6%，3 年内总体死亡率为 45.5%。预先存在 CKD 的 AKI 导致了 47.1%的 iHD。
这对从业者有什么影响？
卫生服务规划和社区卫生可能受益于 AKI 预防策略的实施，以及与用于监测前瞻性 iHD 的数据集建立可持续和永久的联系。
