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Temporal trends in acute kidney injury across health care settings in the Irish health system: a cohort study

journal contribution
posted on 12.11.2020, 05:00 by A Stack, M Kaballo, Xia Li, M Elsayed, H Johnson, P Murray, R Saran, L Browne
© 2018 The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. Background: Complete ascertainment of the true rates of acute kidney injury (AKI) and emerging trends are essential for planning of preventive strategies within health systems. Methods: We conducted a retrospective cohort study from 2005 to 2014 using data from regional laboratory information systems to determine incidence rates of AKI and severity Stages 1-3 in the Irish health system. Multivariable models were developed to explore annual trends and the contributions of demographic factors, clinical measures, geographic factors and location of medical supervision expressed as adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: From 2005 to 2014, incidence rates of AKI increased from 6.1% (5.8-6.3) to 13.2% (12.7-13.8) per 100 patient-years in men and from 5.0% (4.8-5.2) to 11.5% (11.0-12.0) in women, P < 0.001. Stage 1 AKI accounted for the greatest growth in incidence, from 4.4% (95% CI 4.3-4.6) in 2005 to 10.1% (95% CI 9.8-10.5) in 2014 (P < 0.001 for trend). Compared with 2005, patients in 2014 were more likely to experience AKI [OR 4.53 (95% CI 4.02-5.1) for Stage 1, OR 5.22 (4.16-6.55) for Stage 2 and OR 4.11 (3.05-5.54) for Stage 3], adjusting for changing demographic and clinical profiles. Incidence rates of AKI increased in all locations of medical supervision during the period of observation, but were greatest for inpatient [OR 19.11 (95% CI 17.69-20.64)] and emergency room settings [OR 5.97 (95% CI 5.56-6.42)] compared with a general practice setting (referent). Conclusion: Incidence rates of AKI have increased substantially in the Irish health system, which were not accounted for by changing demographic patterns, clinical profiles or location of medical supervision.

Funding

This study is funded by the Health Research Board (HRA2013-PHR-437 and HRA-2014-PHR-685) and the Midwest Research and Education Foundation, and received support from the Health Research Institute, University of Limerick.

Health Research Board | HRA2013-PHR-437

Health Research Board | HRA-2014-PHR-685

Midwest Research and Education Foundation

Health Research Institute, University of Limerick

History

Publication Date

01/03/2020

Journal

Nephrology Dialysis Transplantation

Volume

35

Issue

3

Pagination

11p. (p. 447-457)

Publisher

Oxford University Press

ISSN

0931-0509

Rights Statement

The Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.

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