Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Figures & data

Table 1  Baseline characteristics and underlying medical problems of patients with AKI needing renal replacement theapy for each event of AKI from 1998 to 2005

Variables	Year
	1998	1999	2000	2001	2002	2003	2004	2005
N	2018	2247	2228	2381	2566	2652	2750	2800
Mean age (yrs)	73.1	73.5	73.1	72.9	72.9	73.0	72.8	72.5
Mean admission-RRT interval (days)	15.7	15.0	15.1	16.6	16.9	16.0	17.0	14.6
Male sex (%)	53.8	52.5	54.6	54.3	54.2	54.3	55.6	55.9
Black race (%)	14.9	15.1	14.6	16.4	17.8	16.3	16.2	15.6
White race (%)	79.0	77.3	78.9	76.7	75.0	77.0	76.6	77.4
Others (%)	6.1	7.6	6.5	6.8	7.2	6.7	7.2	7.0
Sepsis (%)	32.5	34.4	32.3	35.4	39.8	38.9	41.3	41.8
ASHD (%)	48.3	48.2	48.8	47.9	46.3	45.1	45.8	42.8
CHF (%)	63.7	62.0	65.5	62.9	63.4	63.8	61.5	61.1
Stroke (%)	15.1	14.7	15.4	14.4	16.0	14.9	15.5	13.3
PVD (%)	26.7	24.5	24.7	26.4	25.2	25.9	25.9	26.3
GI (%)	17.7	17.1	17.5	18.0	16.1	16.3	15.9	14.6
Liver (%)	5.7	6.0	6.4	8.2	7.5	7.5	8.7	10.4
Dysrrhythmia (%)	47.8	49.3	51.8	52.2	53.2	52.1	51.7	50.4
Cancer (%)	11.1	12.8	12.7	12.5	14.3	12.7	14.4	13.7
Diabetes (%)	35.1	34.3	37.0	39.4	39.4	38.5	38.8	39.9
HTN (%)	54.4	54.6	58.1	57.4	60.9	60.3	61.5	61.9
Anemia (%)	38.5	38.5	38.9	40.4	40.3	42.8	45.3	45.5

Abbreviations: RRT = renal replacement therapy, ASHD = atherosclerotic heart disease, CHF = congestive heart failure, PVD = peripheral vascular disease, GI = gastrointestinal diseases, HTN = hypertension.

Table 2  Distribution of patients' characteristics and underlying medical problems by modalities of dialysis in each event of AKI from 1998 to 2005

Variables	Dialysis modality
	CRRT	DHD	IHD
N	2717	3536	13351
Mean age (yrs)	70.8^‡	72.9^†	73.4
Mean admission-RRT interval (days)	19.0^‡	18.8^‡	14.4
Male sex (%)	1581 (58.2)^‡	1980 (56.0)^†	7129 (53.4)
Race:
Black race (%)	302 (11.1)^‡	506 (14.3)^‡	2323 (17.4)
White race (%)	2271 (83.6)	2807 (79.4)	10040 (75.2)
Others (%)	144 (5.3)	223 (6.3)	988 (7.4)
Sepsis (%)	1359 (50.0)	1529 (43.2)	4443 (33.3)
ASHD (%)	1388 (51.1)^‡	1694 (47.9)^†	6021 (45.1)
CHF (%)	1687 (62.1)	2376 (67.2)^‡	8264 (61.9)
Stroke (%)	345 (12.7)^†	601 (17.0)^†	1976 (14.8)
PVD (%)	807 (29.7)^‡	994 (28.1)^‡	3244 (24.3)
GI (%)	489 (18.0)^†	661 (18.7)^‡	2083 (15.6)
Liver (%)	364 (13.4)^‡	276 (7.8)^†	868 (6.5)
Dysrrhythmia (%)	1668 (61.4)^‡	1931 (54.6)^‡	6435 (48.2)
Cancer (%)	323 (11.9)	492 (13.9)	1749 (13.1)
Diabetes (%)	774 (28.5)^‡	1418 (40.1)	5260 (39.4)
HTN (%)	1117 (41.1)^‡	2192 (62.0)	8238 (61.7)
Anemia (%)	888 (32.7)^‡	1630 (46.1)^‡	5621 (42.1)

^†p value < 0.01, comparison with IHD.

^‡p value < 0.001, comparison with IHD.

Abbreviations: RRT = renal replacement therapy, CRRT = continuous renal replacement therapy, DHD = daily intermittent dialysis, IHD = intermittent hemodialysis, ASHD = atherosclerotic heart disease, CHF = congestive heart failure, PVD = peripheral vascular disease, GI = gastrointestinal diseases, HTN = hypertension.

Table 3  Components of multinomial logistic regression analysis showing variables independently associated with DHD and CRRT when compared with IHD modality after adjustment in individuals with AKI from 1998 to 2005

Variables	OR (CRRT vs. IHD)	95% CI of OR (CRRT vs. IHD)	OR (DHD vs. IHD)	95% CI of OR (DHD vs. IHD)	p value
Year					< 0.0001
1998 (reference)	1.00		1.00
1999	1.03	0.84 to 1.27	0.94	0.81 to 1.10
2000	1.31	1.07 to 1.60	0.93	0.80 to 1.09
2001	1.43	1.17 to 1.74	0.93	0.80 to 1.08
2002	1.75	1.44 to 2.11	0.93	0.80 to 1.08
2003	1.55	1.28 to 1.88	0.89	0.76 to 1.03
2004	1.78	1.47 to 2.14	0.84	0.72 to 0.97
2005	2.17	1.80 to 2.61	0.78	0.67 to 0.91
Age (yrs)	0.98	0.97 to 0.98	0.99	0.99 to 0.99	< 0.0001
Female sex	0.95	0.87 to 1.04	0.91	0.84 to 0.98	< 0.05
Race:					< 0.0001
Black vs. white	0.67	0.59 to 0.77	0.78	0.70 to 0.87
Others vs. white	0.73	0.61 to 0.89	0.81	0.69 to 0.94
Sepsis	1.71	1.56 to 1.87	1.39	1.24 to 1.51	< 0.0001
ASHD	1.30	1.18 to 1.43	0.98	0.90 to 1.06	< 0.0001
CHF	0.97	0.87 to 1.06	1.15	1.06 to 1.25	< 0.005
Stroke	0.88	0.77 to 1.00	1.11	1.00 to 1.23	< 0.01
PVD	1.35	1.22 to 1.49	1.15	1.05 to 1.25	< 0.0001
GI	1.18	1.06 to 1.33	1.13	1.02 to 1.25	< 0.005
Liver	1.67	1.45 to 1.92	1.18	1.02 to 1.36	< 0.0001
Dysrhythmia	1.60	1.46 to 1.76	1.18	1.09 to 1.28	< 0.0001
Cancer	0.93	0.81 to 1.06	1.13	1.01 to 1.26	< 0.05
Diabetes	0.69	0.63 to 0.76	1.01	0.93 to 1.09	< 0.0001
Anemia	0.71	0.65 to 0.78	1.16	1.07 to 1.25	< 0.0001
HTN	0.49	0.44 to 0.53	1.00	0.92 to 1.08	< 0.0001

Abbreviations: OR = odds ratio, CI = confidence interval, CRRT = continuous renal replacement therapy, DHD = daily intermittent dialysis, IHD = intermittent hemodialysis, ASHD = atherosclerotic heart disease, CHF = congestive heart failure, PVD = peripheral vascular disease, GI = gastrointestinal diseases, HTN = hypertension.

Figure 1.  Trend of use of different modalities of dialysis in AKI from 1988 to 2005.

Figure 2.  Trend of mortality in AKI by different modalities of dialysis from 1998 to 2005.