TY - JOUR
T1 - Epidemiology of Renal Replacement Therapy for Critically Ill Patients across Seven Health Jurisdictions
AU - Ziegler, Jennifer
AU - Morley, Katharine
AU - Pilcher, David
AU - Bellomo, Rinaldo
AU - Soares, Marcio
AU - Salluh, Jorge I.F.
AU - Borges, Lunna P.
AU - Bagshaw, Sean M.
AU - Hudson, Darren
AU - Christiansen, Christian F.
AU - Heide-Jorgensen, Uffe
AU - Lone, Nazir I.
AU - Buyx, Alena
AU - McLennan, Stuart
AU - Celi, Leo A.
AU - Rush, Barret
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/10/1
Y1 - 2024/10/1
N2 - Introduction: Acute kidney injury (AKI) requiring treatment with renal replacement therapy (RRT) is a common complication after admission to an intensive care unit (ICU) and is associated with significant morbidity and mortality. However, the prevalence of RRT use and the associated outcomes in critically patients across the globe are not well described. Therefore, we describe the epidemiology and outcomes of patients receiving RRT for AKI in ICUs across several large health system jurisdictions. Methods: Retrospective cohort analysis using nationally representative and comparable databases from seven health jurisdictions in Australia, Brazil, Canada, Denmark, New Zealand, Scotland, and the USA between 2006 and 2023, depending on data availability of each dataset. Patients with a history of end-stage kidney disease receiving chronic RRT and patients with a history of renal transplant were excluded. Results: A total of 4,104,480 patients in the ICU cohort and 3,520,516 patients in the mechanical ventilation cohort were included. Overall, 156,403 (3.8%) patients in the ICU cohort and 240,824 (6.8%) patients in the mechanical ventilation cohort were treated with RRT for AKI. In the ICU cohort, the proportion of patients treated with RRT was lowest in Australia and Brazil (3.3%) and highest in Scotland (9.2%). The in-hospital mortality for critically ill patients treated with RRT was almost fourfold higher (57.1%) than those not receiving RRT (16.8%). The mortality of patients treated with RRT varied across the health jurisdictions from 37 to 65%. Conclusion: The outcomes of patients who receive RRT in ICUs throughout the world vary widely. Our research suggests that differences in access to and provision of this therapy are contributing factors.
AB - Introduction: Acute kidney injury (AKI) requiring treatment with renal replacement therapy (RRT) is a common complication after admission to an intensive care unit (ICU) and is associated with significant morbidity and mortality. However, the prevalence of RRT use and the associated outcomes in critically patients across the globe are not well described. Therefore, we describe the epidemiology and outcomes of patients receiving RRT for AKI in ICUs across several large health system jurisdictions. Methods: Retrospective cohort analysis using nationally representative and comparable databases from seven health jurisdictions in Australia, Brazil, Canada, Denmark, New Zealand, Scotland, and the USA between 2006 and 2023, depending on data availability of each dataset. Patients with a history of end-stage kidney disease receiving chronic RRT and patients with a history of renal transplant were excluded. Results: A total of 4,104,480 patients in the ICU cohort and 3,520,516 patients in the mechanical ventilation cohort were included. Overall, 156,403 (3.8%) patients in the ICU cohort and 240,824 (6.8%) patients in the mechanical ventilation cohort were treated with RRT for AKI. In the ICU cohort, the proportion of patients treated with RRT was lowest in Australia and Brazil (3.3%) and highest in Scotland (9.2%). The in-hospital mortality for critically ill patients treated with RRT was almost fourfold higher (57.1%) than those not receiving RRT (16.8%). The mortality of patients treated with RRT varied across the health jurisdictions from 37 to 65%. Conclusion: The outcomes of patients who receive RRT in ICUs throughout the world vary widely. Our research suggests that differences in access to and provision of this therapy are contributing factors.
KW - Acute kidney injury
KW - Intensive care unit
KW - Outcomes
KW - Renal replacement therapy
UR - http://www.scopus.com/inward/record.url?scp=85205604777&partnerID=8YFLogxK
U2 - 10.1159/000539811
DO - 10.1159/000539811
M3 - Article
C2 - 38889694
AN - SCOPUS:85205604777
SN - 0250-8095
VL - 55
SP - 539
EP - 550
JO - American Journal of Nephrology
JF - American Journal of Nephrology
IS - 5
ER -