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. 2022 Feb;17(2):184-193.
doi: 10.2215/CJN.01730221.

In-Hospital and 1-Year Mortality Trends in a National Cohort of US Veterans with Acute Kidney Injury

Ryann Sohaney  1   2 , Huiying Yin  1   3 , Vahakn Shahinian  1   3 , Rajiv Saran  1   3   4 , Nilka Ríos Burrows  5 , Meda E Pavkov  5 , Tanushree Banerjee  6 , Chi-Yuan Hsu  7 , Neil Powe  6 , Diane Steffick  1   3 , Kara Zivin  8   9 , Michael Heung  1   3 ; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
Collaborators, Affiliations

In-Hospital and 1-Year Mortality Trends in a National Cohort of US Veterans with Acute Kidney Injury

Ryann Sohaney et al. Clin J Am Soc Nephrol. 2022 Feb.

Abstract

Background and objectives: AKI, a frequent complication among hospitalized patients, confers excess short- and long-term mortality. We sought to determine trends in in-hospital and 1-year mortality associated with AKI as defined by Kidney Disease Improving Global Outcomes consensus criteria.

Design, setting, participants, & measurements: This retrospective cohort study used data from the national Veterans Health Administration on all patients hospitalized from October 1, 2008 to September 31, 2017. AKI was defined by Kidney Disease Improving Global Outcomes serum creatinine criteria. In-hospital and 1-year mortality trends were analyzed in patients with and without AKI using Cox regression with year as a continuous variable.

Results: We identified 1,688,457 patients and 2,689,093 hospitalizations across the study period. Among patients with AKI, 6% died in hospital, and 28% died within 1 year. In contrast, in-hospital and 1-year mortality rates were 0.8% and 14%, respectively, among non-AKI hospitalizations. During the study period, there was a slight decline in crude in-hospital AKI-associated mortality (hazard ratio, 0.98 per year; 95% confidence interval, 0.98 to 0.99) that was attenuated after accounting for patient demographics, comorbid conditions, and acute hospitalization characteristics (adjusted hazard ratio, 0.99 per year; 95% confidence interval, 0.99 to 1.00). This stable temporal trend in mortality persisted at 1 year (adjusted hazard ratio, 1.00 per year; 95% confidence interval, 0.99 to 1.00).

Conclusions: AKI associated mortality remains high, as greater than one in four patients with AKI died within 1 year of hospitalization. Over the past decade, there seems to have been no significant progress toward improving in-hospital or long-term AKI survivorship.

Keywords: acute kidney injury; cohort studies; epidemiology and outcomes; mortality; veterans.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Cohort derivation. VA, Veterans Affairs.
Figure 2.
Figure 2.
Crude mortality trends among US veterans stratified by AKI status, 2009–2017. (A) In-hospital mortality; (B) 1-year mortality. Vertical bars represent 95% confidence intervals. AKI-D, dialysis-requiring AKI.
Figure 3.
Figure 3.
Crude mortality trends among US veterans stratified by Kidney Disease Improving Global Outcomes AKI stage, 2009–2017. (A) In-hospital mortality; (B) 1-year mortality. Stage 3 AKI includes AKI-D. Vertical bars represent 95% confidence intervals.
See this image and copyright information in PMC

Comment in

References

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