title: Six-year single-center survey on AKI requiring renal replacement therapy: epidemiology and health care organization aspects.
abstract: Evidence regarding hospital-based acute kidney injury (AKI) reveals a continuous increase in incidence over the years, at least in intensive care units (ICU). Fewer reports are available for non critically-ill patients admitted to general or specialist wards other than ICU (non-ICU). The consequence of greater incidence is an increase in therapies such as dialysis; but how the health care organization deals with this problem is not clearly known. Here we quantified the incidence of dialysis-requiring AKI (AKI-D) among patients admitted to a University Hospital which serves a population of 354,000 inhabitants. Between 2007 and 2012, the incidence of AKI-D increased from 209 to 410 per million population (pmp)/year; age of patients and cardiovascular comorbid pathologies also increased. AKI-D was more frequent in non-ICU and 32% of patients were admitted to ICU. Considering the site of treatment of non-ICU patients, in 2007 the ratio of patients admitted to non-ICU wards apart from Nephrology to those admitted to Nephrology was 1:1, but in 2012 the ratio increased to 2.4:1 (p < 0.05). The complexity of acute disease, measured with the New Simplified Acute Physiology Score (SAPS II), did not reveal differences over the years. The number of dialysis treatments/year increased by 82%, and the total hours/year increased by 86%. Low-efficiency daily dialysis was performed in 52.4% of patients admitted to ICU, but dialysis sessions longer than 8 h were performed in only 40% of cases. Overall, 6-year mortality was 48.8%, without significant differences over the years. Mortality in ICU was 65.6%, and in non-ICU 41.2% (p < 0.001). Dialysis treatments needed to be continued after hospital discharge in 21% of patients. We conclude that dialysis-requiring AKI is becoming more common, and that two-thirds of patients are admitted as non-ICU: in these patients, during the last year of the study, the treatment site was more frequently in non-ICUs other than Nephrology. Over the 6-year period, the local healthcare organization had to dispense 80% more dialysis treatments/year in terms of total number and hours of treatment. One-fifth of surviving patients needed to continue dialysis after hospital discharge. Our data highlight the public health importance of AKI and the need for adequate resources for Nephrology.
authors.affiliation: S.C.Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria di Perugia, S.Andrea delle Fratte, 06123, Perugia, Italy, rmfag@fastwebnet.it.
authors.forename: Riccardo Maria
authors.initials: RM
authors.lastname: Fagugli
authors.forename: Francesco
authors.initials: F
authors.lastname: Patera
authors.forename: Sara
authors.initials: S
authors.lastname: Battistoni
authors.forename: Francesca
authors.initials: F
authors.lastname: Mattozzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome