Trends in One-Year Outcomes of Dialysis-Requiring Acute Kidney Injury in Denmark 2005-2012: A Population-Based Nationwide Study

PLoS One. 2016 Jul 26;11(7):e0159944. doi: 10.1371/journal.pone.0159944. eCollection 2016.

Abstract

Background: Dialysis-requiring acute kidney injury (AKI) is associated with substantial mortality and risk of end-stage renal disease (ESRD). Despite considerable growth in incidence of severe AKI, information pertaining to trends in outcomes remains limited. We evaluated time trends in one year risks of ESRD and death in patients with dialysis-requiring AKI over an eight year period in Denmark.

Methods: In a retrospective nationwide study based on national registers, all adults requiring acute renal replacement therapy between 2005 and 2012 were identified. Patients with preceding ESRD were excluded. Through individual-level cross-referencing of administrative registries, information pertaining to comorbidity, preceding surgical interventions, and concurrent other organ failure and sepsis was ascertained. Comparisons of period-specific one year odds ratios for ESRD and death were calculated in a multiple logistic regression model.

Results: A total of 13,819 patients with dialysis-requiring AKI were included in the study. Within one year, 1,017 (7.4%) patients were registered with ESRD, and 7,908 (57.2%) patients died. The one-year rate of ESRD decreased from 9.0% between 2005 and 2006 to 6.1% between 2011 and 2012. Simultaneously, the one-year mortality rate decreased from 58.2% between 2005 and 2006 to 57.5% between 2011 and 2012. Consequently, the adjusted odds ratios for the period 2011-2012 (with the period 2005-2006 as reference) were 0.75 (0.60-0.95, p = 0.015) and 0.87 (95% CI 0.78-0.97, p = 0.010) for ESRD and death, respectively.

Conclusions: In a nationwide retrospective study on time trends in one year outcomes following dialysis-requiring AKI, risk of all-cause mortality and ESRD decreased over a period of 8 years.

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / therapy
  • Aged
  • Denmark
  • Female
  • Humans
  • Male
  • Middle Aged
  • Registries / statistics & numerical data*
  • Renal Dialysis / statistics & numerical data*
  • Treatment Outcome

Grants and funding

Dr. Carlson has received grants from The Danish Heart Foundation, The Danish Kidney Foundation, The Department of Cardiology at Gentofte Hospital, and the Department of Nephrology at Herlev Hospital, Helen and Ejnar Bjoernows Foundation, The Danish Society of Nephrology and the Health Foundation. Dr. Olesen has received speaker fees from Bristol-Myers Squibb and Boehringer Ingelheim, and funding for research from the Lundbeck Foundation, Bristol-Myers Squibb, and The Capital Region of Denmark, Foundation for Health Research. Dr. Kamper has received speaker fees from Eli Lilly, Boehringer Ingelheim and MSD. Dr. Vilsbøll has received lecture fees from Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Eli Lilly and Company, Merck Sharp & Dohme, Novo Nordisk, Sanofi, and Zealand Pharma, and is a member of the Advisory Boards of AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Eli Lilly and Company, Merck, Sharp & Dohme, Novo Nordisk and Sanofi. Dr. Torp-Pedersen has research contracts and speaking engagements with Sanofi, Bristol-Meyer, Merck, Biotronic and Bayer. Further, a research grant has been provided by Novo Nordisk Foundation. Dr. Gislason is supported by an unrestricted clinical research scholarship from the Novo Nordisk Foundation, and has received research grants from Pfizer/Bristol-Meyer Squibb, Bayer, Boehringer Ingelheim and AstraZeneca, and speaker fees from AstraZeneca, Bayer, Pfizer and Sanofi-Aventis. Funding from commercial sources, i.e., Bristol-Myers Squibb did not alter the authors' adherence to PLOS ONE policies on sharing data and materials. The opinions, results, and conclusions in this paper are solely representative of the authors, and are fully independent from funding sources, and no conflicts of interest exist. Additionally, the results presented in this paper have not been published previously in whole or part, except in abstract format. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript, and the opinions, results, and conclusions in this paper are solely representative of the authors, and are fully independent from funding sources.