title: Acute Kidney Injury Requiring Dialysis in Severe Sepsis.
abstract: BACKGROUND
  Understanding the changing incidence and impact of acute kidney injury requiring dialysis in patients with severe sepsis will allow better risk stratification, design of clinical trials, and guide resource allocation.
  
  
  OBJECTIVE
  To assess the longitudinal incidence of acute kidney injury requiring dialysis and its impact on mortality in patients with severe sepsis.
  
  
  METHODS
  Retrospective cohort study of adults (≥20 yr) hospitalized with severe sepsis from 2000 to 2009 in the United States using a nationally representative database.
  
  
  RESULTS
  We calculated the incidences of acute kidney injury requiring dialysis and mortality over time. We used linear regression to assess temporal trends. We used logistic regression to estimate the odds of acute kidney injury requiring dialysis and mortality. Of the estimated 5,257,907 hospitalizations with severe sepsis, 6.1% had acute kidney injury requiring dialysis. The odds of acquiring acute kidney injury requiring dialysis increased by 14% in 2009 compared with 2000. Mortality in patients with acute kidney injury requiring dialysis was higher (43.6% vs. 24.9%; P < 0.001). After multivariable adjustment, odds of mortality declined 61% by the year 2009. Acute kidney injury requiring dialysis remained an independent predictor of mortality in patients with severe sepsis, although its influence on mortality declined with time.
  
  
  CONCLUSIONS
  Incidence of acute kidney injury requiring dialysis in patients with severe sepsis has increased over time; conversely, associated mortality has declined. The likelihood of demise from acute kidney injury requiring dialysis in patients with severe sepsis has also declined.
authors.affiliation: 1 Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ankit
authors.initials: A
authors.lastname: Sakhuja
authors.affiliation: 2 Department of Critical Care, Phoebe Putney Memorial Hospital, Albany, Georgia.
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
authors.affiliation: 3 Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Shipra
authors.initials: S
authors.lastname: Gupta
authors.affiliation: 4 Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio; and.
authors.forename: Tarun
authors.initials: T
authors.lastname: Mittal
authors.affiliation: 5 Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Amit
authors.initials: A
authors.lastname: Taneja
authors.affiliation: 5 Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Nanchal
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D006435:Renal Dialysis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: acute kidney injury; dialysis; sepsis