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Impact of end‐stage renal disease on hospital outcomes among patients admitted to intensive care units: A retrospective matched‐pair cohort study
Author(s) -
Iwagami Masao,
Yasunaga Hideo,
Matsui Hiroki,
Horiguchi Hiromasa,
Fushimi Kiyohide,
Noiri Eisei,
Nangaku Masaomi,
Doi Kent
Publication year - 2017
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12830
Subject(s) - medicine , odds ratio , end stage renal disease , intensive care , retrospective cohort study , confidence interval , intensive care unit , mechanical ventilation , confounding , logistic regression , cohort , renal replacement therapy , cohort study , emergency medicine , intensive care medicine , disease
Aim We aimed to estimate the burden of end‐stage renal disease (ESRD) among patients admitted to intensive care units (ICUs), by comparing hospital outcomes between patients with and without ESRD. Methods Using the Japanese Diagnosis Procedure Combination database, we identified patients aged 20 years or older who were admitted to ICUs for ≥3 days (2 nights) in 2011. We created a matched cohort of patients with and without ESRD for hospital, age, sex, main diagnosis category, and ICU admission type (medical or surgical) at a maximum ratio of 1:3. For these matched patients, we compared patient characteristics, treatment regimens at ICU admission, and hospital outcomes. We also performed a multivariable logistic regression analysis for the associations between ESRD and 28‐day (counting from ICU admission) and in‐hospital mortality. Results Among the 164 423 eligible patients, 7998 (4.9%) had ESRD, from which 5228 ESRD and 12 274 non‐ESRD patients were matched for the aforementioned factors. Compared to non‐ESRD patients, ESRD patients were on more intensive treatment regimens, including mechanical ventilation, vasoactive drugs, and blood transfusion. Patients with ESRD showed significantly higher ICU, 28‐day, and in‐hospital mortality and longer lengths of stay in the ICU and hospital (28‐day mortality: 11.7% vs. 8.3%; P < 0.001, in‐hospital mortality: 21.1% vs. 12.0%; P < 0.001). After adjusting for confounding factors, ESRD was independently associated with 28‐day mortality (adjusted odds ratio: 1.36, 95% confidence interval [CI]: 1.22–1.52) and in‐hospital mortality (adjusted odds ratio: 1.85, 95% CI: 1.69–2.02). Conclusion This study involving the Japanese national inpatient database, with a matched‐pair cohort design, suggested that ESRD is an important burden in the critical care setting.