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. 2020 Aug 10;21(1):336.
doi: 10.1186/s12882-020-02000-7.

Exploring reasons for state-level variation in incidence of dialysis-requiring acute kidney injury (AKI-D) in the United States

Zijin Chen  1   2 , Charles E McCulloch  3 , Neil R Powe  4   5 , Michael Heung  6   7 , Rajiv Saran  6   7 , Meda E Pavkov  8 , Nilka Rios Burrows  8 , Raymond K Hsu  9 , Chi-Yuan Hsu  9 ; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team Neil Powe
Collaborators, Affiliations

Exploring reasons for state-level variation in incidence of dialysis-requiring acute kidney injury (AKI-D) in the United States

Zijin Chen et al. BMC Nephrol. .

Abstract

Background: There is considerable state-level variation in the incidence of dialysis-requiring acute kidney injury (AKI-D). However, little is known about reasons for this geographic variation.

Methods: National cross-sectional state-level ecological study based on State Inpatient Databases (SID) and the Behavioral Risk Factor Surveillance System (BRFSS) in 2011. We analyzed 18 states and six chronic health conditions (diabetes mellitus [diabetes], hypertension, chronic kidney disease [CKD], arteriosclerotic heart disease [ASHD], cancer (excluding skin cancer), and chronic obstructive pulmonary disease [COPD]). Associations between each of the chronic health conditions and AKI-D incidence was assessed using Pearson correlation and multiple regression adjusting for mean age, the proportion of males, and the proportion of non-Hispanic whites in each state.

Results: The state-level AKI-D incidence ranged from 190 to 1139 per million population. State-level differences in rates of hospitalization with chronic health conditions (mostly < 3-fold difference in range) were larger than the state-level differences in prevalence for each chronic health condition (mostly < 2.5-fold difference in range). A significant correlation was shown between AKI-D incidence and prevalence of diabetes, ASHD, and COPD, as well as between AKI-D incidence and rate of hospitalization with hypertension. In regression models, after adjusting for age, sex, and race, AKI-D incidence was associated with prevalence of and rates of hospitalization with five chronic health conditions--diabetes, hypertension, CKD, ASHD and COPD--and rates of hospitalization with cancer.

Conclusions: Results from this ecological analysis suggest that state-level variation in AKI-D incidence may be influenced by state-level variations in prevalence of and rates of hospitalization with several chronic health conditions. For most of the explored chronic conditions, AKI-D correlated stronger with rates of hospitalizations with the health conditions rather than with their prevalences, suggesting that better disease management strategies that prevent hospitalizations may translate into lower incidence of AKI-D.

Keywords: AKI-D; Chronic health condition; Ecological study; Geographic variation.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Map demonstrating the regional variation of AKI-D incidence in primary analysis with 18 states. The map was drawn using Adobe Photoshop CS6 version 13.1.2 URL:http://www.adobe.com
Fig. 2
Fig. 2
Pearson correlation between AKI-D incidence and selected chronic health conditions for the 18 states in the primary analysis. a AKI-D incidence and diabetes prevalence. b AKI-D incidence and ASHD prevalence. c AKI-D incidence and COPD prevalence. d AKI-D incidence and CKD prevalence. e AKI-D incidence and rate of hospitalization with hypertension. f AKI-D incidence and rate of hospitalization with CKD
Fig. 3
Fig. 3
Rate of hospitalization with cancer and predicted AKI-D incidence for the 18 states in the primary analysis. a Adjusted for age, % male, and % non-Hispanic White. b Adjusted for age, % male, % non-Hispanic White, and prevalence of cancer
See this image and copyright information in PMC

References

    1. Hsu RK, McCulloch CE, Ku E, Dudley RA, Hsu CY. Regional variation in the incidence of dialysis-requiring AKI in the United States. Clin J Am Soc Nephrol. 2013;8(9):1476–1481. doi: 10.2215/CJN.12611212. - DOI - PMC - PubMed
    1. Hsu RK, McCulloch CE, Heung M, et al. Exploring potential reasons for the temporal trend in dialysis-requiring AKI in the United States. Clin J Am Soc Nephrol. 2016;11(1):14–20. doi: 10.2215/CJN.04520415. - DOI - PMC - PubMed
    1. Chen Z, Lee BJ, McCulloch CE, et al. The relation between dialysis-requiring acute kidney injury and recovery from end-stage renal disease: a national study. BMC Nephrol. 2019;20(1):342. doi: 10.1186/s12882-019-1483-y. - DOI - PMC - PubMed
    1. HCUP State Inpatient Databases (SID). Healthcare cost and utilization project (HCUP). Rockville: Agency for Healthcare Research and Quality; 2005-2009. www.hcup-us.ahrq.gov/sidoverview.jsp. Accessed 14 Sept 2018.
    1. CDC BRFSS. https://www.cdc.gov/brfss/index.html. Accessed 1 Oct 2018.

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