Long-term outcomes following vehicle trauma related acute kidney injury requiring renal replacement therapy: a nationwide population study

Abstract

Acute kidney injury (AKI) is a frequent complication of traumatic injury; however, long-term outcomes such as mortality and end-stage kidney disease (ESKD) have been rarely reported in this important patient population. We compared the long-term outcome of vehicle-traumatic and non-traumatic AKI requiring renal replacement therapy (AKI-RRT). This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Vehicle-trauma patients who were suffered from vehicle accidents developing AKI-RRT during hospitalization were identified, and matching non-traumatic AKI-RRT patients were identified between 2000 and 2010. The incidences of ESKD, 30-day, and long-term mortality were evaluated, and clinical and demographic associations with these outcomes were identified using Cox proportional hazards regression models. 546 vehicle-traumatic AKI-RRT patients, median age 47.6 years (interquartile range: 29.0-64.3) and 76.4% male, were identified. Compared to non-traumatic AKI-RRT, vehicle-traumatic AKI-RRT patients had longer length of stay in hospital [median (IQR):15 (5-34) days vs. 6 (3-11) days; p < 0.001). After propensity matching with non-traumatic AKI-RRT cases with similar demographic and clinical characteristics. Vehicle-traumatic AKI-RRT patients had lower rates of long-term mortality (adjusted hazard ratio (HR), 0.473; 95% CI, 0.392-0.571; p < 0.001), but similar rates of ESKD (HR, 1.166; 95% CI, 0.829-1.638; p = 0.377) and short-term risk of death (HR, 1.134; 95% CI, 0.894-1.438; p = 0.301) as non-traumatic AKI-RRT patients. In competing risk models that focused on ESKD, vehicle-traumatic AKI-RRT patients were associated with lower ESKD rates (HR, 0.552; 95% CI, 0.325-0.937; p = 0.028) than non-traumatic AKI-RRT patients. Despite severe injuries, vehicle-traumatic AKI-RRT patients had better long-term survival than non-traumatic AKI-RRT patients, but a similar risk of ESKD. Our results provide a better understanding of long-term outcomes after vehicle-traumatic AKI-RRT.

Figure 1

Flow chart of the participants.

Figure 2

Temporal patterns of annual number of trauma cases (a) and annual rate of vehicle-traumatic AKI-RRT (b) stratified by age groups (annual rate of vehicle-traumatic AKI-RRT = annual number of vehicle-traumatic AKI-RRT/ annual number of trauma cases). (b) p for trend, age ≦ 44: 0.073, 45 < age < 65: 0.183, age ≧ 65: 0.004).

Figure 3

Temporal patterns of annual number of trauma cases (a) and annual rate of traumatic AKI-RRT (b) stratified by injured body part (annual rate of vehicle-traumatic AKI-RRT = annual number of vehicle-traumatic AKI-RRT/ annual number of trauma cases). (b) p for trend, brain: 0.697, bones: 0.186, chest: 0.484, abdomen: 0.484, Skin: 0.024).