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Abstract: TH-PO029

Incidence and Outcomes of Dialysis-Requiring AKI in Taiwan—A Nationwide Study 2003-2014

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Author

  • Chen, Jinn-Yang, Taipei Veterans General Hospital, Taipei, Taiwan
Background

Dialysis-requiring acute kidney injury (AKI-D) is associated with high morbidity and mortality. Despite increasing incidence of AKI-D, information pertaining to trends and prognosis remains limited due to underreporting of discharge code of AKI code and differences in definition. We identify first in-hospital dialysis using procedure code to evaluate the time trend and outcome of AKI-D over a twelve-year period in Taiwan.

Methods

In a retrospective nationwide study based on National Health Insurance Database 2000-2015, all adults requiring the first hospitalized dialysis treatment between 2003 and 2014 were identified. Patients with previous renal transplantation or chronic dialysis were excluded. Through cross-linking of several administrative datasets, information pertaining to comorbidity, concurrent surgical interventions and sepsis, and clinical outcome were ascertained.

Results

A total of 203,071 first hospitalized dialysis was retrieved. Among them, 22,746 patients (11.2%) had advanced chronic kidney disease (CKD); 121,054 patients (59.6%) had history of CKD; 59,271 patients (29.2%) received dialysis during admission without documented CKD. Among patients without pre-existing CKD, 46.7% had sepsis; 6.6% were related to cardiac surgery; 91.2% had been admitted to ICU and 42.5% received CRRT. Patients without pre-existing CKD showed the highest in-hospital mortality (71.1%). However, only 47% of patients without pre-existing CKD could be identified with ICD-9 code of acute kidney injury (584). Time trend analysis showed that there were decreased trends of in-hospital mortality and increased trends of long-term dialysis from 2003 to 2014. For those who was discharged without receiving regular dialysis, 25% and 12% of patients died within 1 and 2 years after discharge.

Conclusion

In a nationwide retrospective study of 1st hospitalized dialysis treatment using procedure code, we found AKI-D was underreported and associated with high mortality. For the AKI-D survivors, high mortality was also noted.