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. 2019 Feb 7;14(2):e0211541.
doi: 10.1371/journal.pone.0211541. eCollection 2019.

Increased incidence of acute kidney injury requiring dialysis in metropolitan France

Fanny Garnier  1   2 , Cécile Couchoud  3 , Paul Landais  2 , Olivier Moranne  1   2
Affiliations

Increased incidence of acute kidney injury requiring dialysis in metropolitan France

Fanny Garnier et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart.
AKI-D, acute kidney injury requiring dialysis; ICD-10, International Classification of disease 10th version; CCMP, Common Classification of Medical Procedures. DOM TOM, French overseas departments and territories.
Fig 2
Fig 2. Population incidence of acute kidney injury requiring dialysis in metropolitan France from 2009 to 2014 (absolute number of stays and standardized incidence rate per million population).
For 2009, the absolute number of stays and the crude incidence rate were reported as an estimation over 12 months based on observations for 9 months. I bars represent 95% CIs for standardized incidence rates. * indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.
Fig 3
Fig 3. Population standardized incidence rate of acute kidney injury requiring dialysis in metropolitan France by age group from 2009 to 2014.
For 2009, the standardized incidence rate was reported as an estimation over 12 months from observations over 9 months. I bars represent 95% CIs for standardized incidence rates.
Fig 4
Fig 4. Trends in principal diagnoses of patients with AKI requiring dialysis from 2009 to 2014.
* indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.
See this image and copyright information in PMC

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