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Incidence of Acute Kidney Injury Decreases in California Health Care System

Favorable Trend in Contrast to National Incidence Rates of AKI

OAKLAND, CA — In contrast to national hospital data suggesting that acute kidney injury (AKI) has continued to increase over time throughout the United States, researchers have found that hospitalized acute kidney injury decreased from 2008 through 2011 within the large, integrated health care delivery system of Kaiser Permanente Northern California.

The findings were presented at the American Society of Nephrology annual meeting, Kidney Week, in Atlanta on November 7.

Lead author Alan S. Go, MD, chief of the Cardiovascular and Metabolic Conditions section of the Kaiser Permanente Division of Research, noted that the changes in acute kidney injury incidence were not explained by any underlying changes in population demographics or the frequency of pre-admission clinical risk factors for acute kidney injury.

In collaboration with the Divisions of Nephrology at the Kaiser Permanente Oakland Medical Center and the University of California at San Francisco, researchers tracked the population of 3,910,697 Kaiser Permanente adult members from January 2004 through December 2011 for incidence of non-dialysis-requiring and dialysis-requiring acute kidney injury. The mean age was 48 years, 52 percent were women, and 40 percent were persons of color.

Acute kidney injury, also commonly referred to as acute renal failure, in hospitalized patients has negative implications of higher short- and longer-term mortality risks, development or worsening of chronic kidney disease, and other potential clinical complications. Recent data based on administrative claims from the National Inpatient Sample suggest dialysis-requiring acute kidney injury has increased approximately 10 percent per year between 2000 and 2009.

During the study period, there was a 15 percent relative increase in hospitalized acute kidney injury between 2004 and 2007, followed by a significant decrease of 11 percent between 2008 and 2011.

“We are excited by these findings because they suggest that possible changes in clinical management have contributed, at least in part, to this phenomenon,” said Go.

The researchers say additional studies are needed to evaluate how changes in targeted management practices — for example, reduced contrast, avoidance of nephrotoxic therapies and more aggressive fluid resuscitation — may explain these recent favorable trends in the decreasing incidence of acute kidney injury and advance them further.

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