In-Hospital and 1-Year Mortality Trends in a National Cohort of US Veterans with Acute Kidney Injury
- PMID: 35131927
- PMCID: PMC8823933
- DOI: 10.2215/CJN.01730221
In-Hospital and 1-Year Mortality Trends in a National Cohort of US Veterans with Acute Kidney Injury
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.
Copyright © 2022 by the American Society of Nephrology.
Figures




Comment in
-
Improved Survival after Acute Kidney Injury: Past and Future.Clin J Am Soc Nephrol. 2022 Feb;17(2):179-181. doi: 10.2215/CJN.16351221. Clin J Am Soc Nephrol. 2022. PMID: 35131925 Free PMC article. No abstract available.
References
-
- United States Renal Data System : 2018 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018. Available at: https://adr.usrds.org/2021/chronic-kidney-disease/4-acute-kidney-injury. Accessed September 30, 2021
-
- See EJ, Jayasinghe K, Glassford N, Bailey M, Johnson DW, Polkinghorne KR, Toussaint ND, Bellomo R: Long-term risk of adverse outcomes after acute kidney injury: A systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int 95: 160–172, 2019 - PubMed
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Miscellaneous