title: Regional Variation in Acute Kidney Injury Requiring Dialysis in the English National Health Service from 2000 to 2015 - A National Epidemiological Study.
abstract: BACKGROUND
  The absence of effective interventions in presence of increasing national incidence and case-fatality in acute kidney injury requiring dialysis (AKI-D) warrants a study of regional variation to explore any potential for improvement. We therefore studied regional variation in the epidemiology of AKI-D in English National Health Service over a period of 15 years.
  
  
  METHODS
  We analysed Hospital Episode Statistics data for all patients with a diagnosis of AKI-D, using ICD-10-CM codes, in English regions between 2000 and 2015 to study temporal changes in regional incidence and case-fatality.
  
  
  RESULTS
  Of 203,758,879 completed discharges between 1st April 2000 and 31st March 2015, we identified 54,252 patients who had AKI-D in the nine regions of England. The population incidence of AKI-D increased variably in all regions over 15 years; however, the regional variation decreased from 3·3-fold to 1·3-fold (p<0·01). In a multivariable adjusted model, using London as the reference, in the period of 2000-2005, the North East (odd ratio (OR) 1·38; 95%CI 1·01, 1·90), East Midlands (OR 1·38; 95%CI 1·01, 1·90) and West Midlands (OR 1·38; 95%CI 1·01, 1·90) had higher odds for death, while East of England had lower odds for death (OR 0·66; 95% CI 0·49, 0·90). The North East had higher OR in all three five-year periods as compared to the other eight regions. Adjusted case-fatality showed significant variability with temporary improvement in some regions but overall there was no significant improvement in any region over 15 years.
  
  
  CONCLUSIONS
  We observed considerable regional variation in the epidemiology of AKI-D that was not entirely attributable to variations in demographic or other identifiable clinical factors. These observations make a compelling case for further research to elucidate the reasons and identify interventions to reduce the incidence and case-fatality in all regions.
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Nitin V
authors.identifier: http://orcid.org/0000-0003-2528-4436
authors.initials: NV
authors.lastname: Kolhe
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fluck
authors.affiliation: Department of Public Health, Derby City Council, Corporation Street, Derby, DE1 2FS, United Kingdom.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Muirhead
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.|Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Taal
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D004739:England / Q000453:epidemiology; D016021:Epidemiologic Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D016017:Odds Ratio; D006435:Renal Dialysis