The growth of acute kidney injury: a rising tide or just closer attention to detail?

Edward D Siew, Andrew Davenport, Edward D Siew, Andrew Davenport

Abstract

Acute kidney injury (AKI), previously termed acute renal failure, is associated with increased mortality, prolonged hospital stay, and accelerated chronic kidney disease (CKD). Over the past 2 decades, dramatic rises in the incidences of AKI have been reported, particularly within the United States. The question arises as to whether these changes reflect actual increases in disease incidence, or are potentially explained by the introduction of consensus definitions that rely on small standardized changes in serum creatinine, changes in coding and reimbursement, or increasingly available and more liberal use of dialysis. In this review, we explore the secular trends in AKI incidence in North America and Western Europe and its potential contributors.

Figures

Figure 1
Figure 1
Temporal trends in the hospital-based and population-based incidence of acute kidney injury (AKI). (a) Hospital-based incidence in AKI among elderly (aged >65 years) Medicare beneficiaries using administrative codes (USA). (b, c) Community-based incidence of nondialysis- and dialysis-requiring AKI in Northern California (USA) using administrative codes and creatinine-based definitions, respectively. (d) Population incidence of dialysis-requiring AKI using the Nationwide Inpatient Sample and US Census data. ARF, acute renal failure.
Figure 2
Figure 2
Temporal trends in sepsis and heart failure hospitalizations. National US trends of hospital discharges for (a) sepsis using the Nationwide Inpatient Sample (USA) and (b) congestive heart failure using the National Hospital Discharge Survey (USA).
Figure 3
Figure 3
Temporal trends in MI and surgery associated acute kidney injury (AKI). Temporal trends in the incidence of dialysis-requiring AKI during hospitalization for (a) acute myocardial infarction in the United States and (b) major surgery in Ontario, Canada.
Figure 4
Figure 4
Proposed framework by the Acute Dialysis Quality Initiative (ADQI) for evaluating acute kidney injury (AKI) using both functional and damage markers simultaneously.,

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