Kidney Week

Abstract: TH-PO0711

CKRT in an Aging Society: A 15-Year Nationwide Analysis of Use and Mortality in South Korea

Session Information

• AKI: Prevention, Diagnostics, and Management
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Gu, Juyeon, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Juyeon Gu, MD

• Cho, Yoon Jung, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoon Jung Cho, MD

• Jang, Yoonjoo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoonjoo Jang, MD

• Lee, Kyungho, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Kyungho Lee, MD, PhD

• Jeon, Junseok, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Junseok Jeon, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Wooseong Huh, MD, PhD

• Chung, Byung ha, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)

Byung ha Chung, MD, PhD

• Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

Background

The global aging of populations has reshaped critical care delivery, yet temporal trends and age-specific outcomes of continuous kidney replacement therapy (CKRT) remain to be elucidated. South Korea—one of the most rapidly aging societies worldwide and among the highest CKRT-utilizing countries—provides a unique setting to examine how the expanding application of CKRT in older patients influences clinical outcomes. We conducted a nationwide analysis of CKRT utilization and mortality trends, stratified by age.

Methods

Using the Korean National Health Insurance Service database, we identified 209,260 adult patients who initiated CKRT between 2007 and 2021. Patients were stratified into four age groups: 20–44, 45–64, 65–74, and ≥75 years. We assessed temporal trends in baseline characteristics and three mortality endpoints: in-hospital mortality and 1-year and 3-year post-discharge mortality. Multivariable logistic and Cox regression models were estimated to assess adjusted mortality risks across calendar years and age strata, accounting for sex, comorbidities, and procedural variables.

Results

Annual CKRT cases increased more than 4-fold, from approximately 5,000 in 2007 to 22,500 in 2021. Mean age at CKRT initiation rose from 63.8 to 68.9 years, and the proportion of patients aged ≥75 years nearly doubled from 24.6% to 41.3%. Unadjusted in-hospital mortality declined from 62% to 53% across all age groups. However, after multivariable adjustment, patients aged ≥75 years showed no significant improvement in in-hospital mortality over time, whereas younger patients demonstrated substantial reductions in adjusted mortality risk, suggesting differential benefit of CKRT expansion across age groups. Post-discharge mortality remained persistently high, approximately 40–45% at 1 year and 30% at 3 years among 1-year survivors. Adjusted post-discharge mortality risk decreased modestly over time, without significant age-group differences.

Conclusion

CKRT use in Korea has expanded rapidly, particularly with increased application for older patients. The absence of adjusted mortality improvement in this group raises concerns that CKRT may be increasingly applied to older patients with limited prospects of meaningful recovery. These findings underscore the need for individualized decision-making in elderly CKRT candidates and inform policy planning for aging societies.