US acute kidney injury deaths ‘double in past decade’

By Hannah Noel, medwireNews Reporter

A US study has found that the most severe form of acute kidney injury (AKI) has increased nationwide by an average 10% per year with the number of associated deaths doubling over the past decade.

The findings highlight the public health burden of AKI and, as the authors explain, emphasize the need for future research to examine the reasons behind the rapid increase in AKI incidence, plus underlying disparities among gender, age, and racial groups

The researchers, led by Chi-yuan Hsu (University of California-San Francisco School of Medicine), analyzed data from a nationally representative sample of hospitalizations (the Nationwide Inpatient Sample) to identify patients with AKI requiring dialysis using validated International Classification of Diseases (ICD-9) codes.

They found that from 2000 to 2009, the incidence of dialysis-requiring AKI increased from 222 to 533 cases per million person-years, averaging a 10% increase each year.

"We also found that older age, male sex and black race [were] associated with a higher incidence of the condition," the researchers report in the Journal of the American Society of Nephrology.

In a press release accompanying the paper, co-author Raymond Hsu (University of California-San Francisco School of Medicine) said that "the UCSF team estimates that about 30% of the increase can be attributed to commonly known causes, such as the rise in severe infections, ventilator usage, acute heart failure and cardiac catheterizations over the same time period."

The authors report that the number of deaths associated with dialysis-requiring AKI more than doubled over the study period, from 18,000 in 2000 to nearly 39,000 in 2009. This growth occurred despite the inpatient case fatality rate from single episodes of dialysis-requiring AKI declining from 29.1% in 2000 to 23.5% in 2009.

Chi-yuan Hsu notes: "The epidemic of acute kidney disease is largely a silent one, because the organ itself is so redundant in structure and steadfast in function."

He adds: "Even if you were to lose 80% of your kidney function, you wouldn't feel it. But once the insult to the kidneys becomes severe enough to require a patient to go on dialysis, the result is often fatal - about one-fifth of patients with acute kidney injury requiring dialysis in the study died."

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