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Kidney Week

Abstract: FR-PO002

Underreporting of In-Hospital AKI in Taiwan: A Nationwide Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Author

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



Hospital-acquired AKI is associated with high morbidity and mortality. We used ICD-9 CM code and Taiwanese National Health Insurance (NHI) dialysis procedure codes to identify in-hospital acute kidney injury and evaluate their outcomes over a twelve years period in Taiwan.


Methods

In a nationwide retrospective study based on the NHI Database, we identified all adult patients requiring the first in-hospital dialysis, or with ICD-9 code 584 between 2003 and 2014. We excluded patients with previous renal transplantation or chronic dialysis from 2000 to 2002.

Results


A total of 628,120 in-hospital AKI episodes were identified, and 203,064 episodes were dialysis-requiring AKI. Among 203,064 dialysis-requiring AKI episodes, 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%). Time trend analysis showed that there were decreased trends of in-hospital mortality and increasing 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


We found in-hospital AKI was severely under-reported and was associated with high mortality. Strategies to increase the accuracy of discharge diagnosis is required to improve patient safety.

Funding

  • Government Support - Non-U.S.