title: Current state of continuous renal replacement therapy for acute kidney injury in Japanese intensive care units in 2011: analysis of a national administrative database.
abstract: BACKGROUND
  Nationwide data for the prevalence and outcomes of patients receiving continuous renal replacement therapy (CRRT) in intensive care units (ICUs) are scarce. This study assessed the status of CRRT in Japanese ICUs using a nationwide administrative claim database.
  
  
  METHODS
  Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. From a cohort of critically ill patients aged 12 years or older who were admitted to ICUs for 3 days or longer, acute kidney injury (AKI) patients treated with CRRT were identified. The period prevalence of CRRT and in-hospital mortality were calculated. Logistic regression analysis identified factors associated with in-hospital mortality.
  
  
  RESULTS
  Of 165 815 ICU patients, 6478 (3.9%) received CRRT for AKI. The most frequent admission diagnosis category was diseases of the circulatory system (n = 3074). The overall in-hospital mortality rate of the CRRT-treated AKI patients was 50.6%. Clustering patients into four groups by background revealed the lowest in-hospital mortality rate of 41.5% for the cardiovascular surgery group (n = 1043) compared with 53.5% for the nonsurgical cardiovascular group (n = 2031), 51.7% for the sepsis group (n = 1863) and 51.6% for other cases (n = 1541). Multiple logistic regression analysis showed a significant association of these four group classifications with in-hospital mortality in addition to age, hospital characteristics (type and volume), time from hospital admission to CRRT initiation and interventions performed on the day of CRRT initiation.
  
  
  CONCLUSIONS
  Using a large Japanese nationwide database, this study revealed remarkably high in-hospital mortality of CRRT-treated AKI patients, although the period prevalence of CRRT for AKI in ICUs was low.
authors: Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan.
authors: Masao
authors: M
authors: Iwagami
authors: Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors: Hideo
authors: H
authors: Yasunaga
authors: Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
authors: Eisei
authors: E
authors: Noiri
authors: Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
authors: Hiromasa
authors: H
authors: Horiguchi
authors: Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors: Kiyohide
authors: K
authors: Fushimi
authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
authors: Takehiro
authors: T
authors: Matsubara
authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
authors: Naoki
authors: N
authors: Yahagi
authors: Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
authors: Masaomi
authors: M
authors: Nangaku
authors: Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
authors: Kent
authors: K
authors: Doi
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy / Q000401:mortality*; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
keywords: acute kidney injury; cardiorenal syndrome; cardiovascular surgery; continuous renal replacement therapy; sepsis