title: The impact of dialysis-requiring acute kidney injury on long-term prognosis of patients requiring prolonged mechanical ventilation: nationwide population-based study.
abstract: BACKGROUND
  Prolonged mechanical ventilation (PMV) is increasingly common worldwide, consuming enormous healthcare resources. Factors that modify PMV outcome are still obscure.
  
  
  METHODS
  We selected patients without preceding mechanical ventilation within the one past year and who developed PMV during index admission in Taiwan's National Health Insurance (NHI) system during 1998-2007 for comparison of mortality and resource use. They were divided into three groups: (1) patients with end-stage renal diseases (ESRD) before the index admission for PMV onset; (2) patients with dialysis-requiring acute kidney injury (AKI-dialysis) during the hospitalization course; and (3) patients without AKI or with non dialysis-requiring AKI during the hospitalization course (non-AKI). We used a random-effects logistic regression model to identify factors associated with mortality.
  
  
  RESULTS
  Compared with the other two groups, patients with AKI-dialysis had significantly longer mechanical ventilation, more frequent use of vasopressors, longer intensive care unit/hospital stay and higher inpatient expenditures during the index admission. Relative to non-AKI patients, patients with AKI-dialysis had an elevated mortality hazard; the adjusted relative risk ratios were 1.51 (95% confidence interval [CI]:1.46-1.56), 1.27 (95% CI: 1.23-1.32), and 1.10 (95% CI: 1.08-1.12) for mortality rates at discharge, 3 months, and 4 years after PMV, respectively. Patients with AKI-dialysis also consumed significantly higher total in-patient expenditure than the other two patient groups (p<0.001).
  
  
  CONCLUSIONS
  Among patients that need PMV care during an admission, the presence of de novo AKI requiring dialysis significantly increased short and long term mortality, and demand for health care resources.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chia-Ter
authors.initials: CT
authors.lastname: Chao
authors.forename: Chun-Cheng
authors.initials: CC
authors.lastname: Hou
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Hsin-Ming
authors.initials: HM
authors.lastname: Lu
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Wang
authors.forename: Likwang
authors.initials: L
authors.lastname: Chen
authors.forename: Tze-Wah
authors.initials: TW
authors.lastname: Kao
mesh_terms: D058186:Acute Kidney Injury / Q000191:economics / Q000401:mortality* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006306:Health Surveys; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality* / Q000628:therapy; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000191:economics / Q000401:mortality*; D012121:Respiration, Artificial / Q000191:economics / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D016896:Treatment Outcome