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Trends in Incidence Rate of Acute Kidney Injury by Diagnosis Code

The incidence rate of newly diagnosed AKI has increased from 80 per 1,000 patient-years in 2007 to 242 per 1,000 patient-years in 2022. The rise in AKI incidence after 2019 may be related to COVID-19 infections during the pandemic and then levels off. This analysis included Veterans with at least one AKI hospitalization.

Data Source: NATIONAL VA

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Incidence of Acute Kidney Injury by Diagnosis Code by Overall Veterans Affairs Health System
2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
80.1	84.9	94.2	106.5	120.2	129.9	141.3	150.8	159.7	168.4	178.7	189.5	202.7	234.5	241.3	241.7

End-stage kidney disease is defined as dialysis or transplant. Data are not adjusted.

VHA is America’s largest integrated health care system, providing care at 171 medical centers and 1,113 outpatient sites. VHA serves over 9 million enrolled Veterans each year. National VHA data were examined for Veterans with at least one outpatient visit during the federal fiscal year (October 1 to September 30). Medical conditions were defined by ICD-9-CM and ICD-10-CM diagnosis codes on at least one outpatient claim.

Field	Data
Description of Measure	Incidence of newly diagnosed Acute Kidney Injury (AKI) among U.S. Veterans.
Data Set	VHA national data, using the MedSAS data, and the Corporate Data Warehouse (CDW) LabChem files.
Population	Hospitalized patients in VHA without end-stage kidney disease.
Years Included	2007–2022.
Numerator	Veterans with a diagnosis code for AKI.
Denominator	Veterans aged ≥ 18 years with an inpatient stay of 2 days or more with no ESRD.
Definition of Acute Kidney Injury	AKI is defined by the presence of ICD-9 codes 584.x or ICD-10 codes N16.x on an inpatient stay.
End-Stage Kidney Disease	Dialysis and transplantation were determined from ICD-9 and ICD-10 codes as follows: Dialysis: ICD-9, V56.x, E879.1x, 585.6; ICD10, N18.6, Y84.1, V56, Z49.01, Z49.02, Z49.31, Z49.32; outpatient CPT codes, 90918, 90919, 90921, 90922, 90923, 90925, 90935, 90937, 90940, 90945, 90947, 90951, 90952-90967, 90997, 90999 and outpatient dialysis clinic (600-611) visits (x and xx stand for all the codes within the main diagnosis). Transplantation: ICD-9, V42.0, 996.81; ICD10, T86.1x, Z48.2x, Z49.xx and if the transplant occurred within VHA (DRG 302, 512 before FY17, 008, 652 after FY17). Procedure/surgery codes: ICD-9,556.9, ICD10, OTYO1, and OTYO2.
Limitations of Indicator	The increase in diagnosed AKI (based on ICD codes) may be due to increased clinical recognition of AKI over time. Yet this may underestimate incidence rates based on the KDIGO definition that uses laboratory values to detect AKI.
Analytical Considerations	Not all veterans use the VHA Health System. These data were not linked to the CMS ESKD program data, so the dialysis and transplant categories may underestimate the true prevalence of ESRD among veterans. It is likely that some veterans with eGFR <15 ml/min/1.73m² in stage 5 receive dialysis outside the VHA Health System.

Kidney Disease Improving Global Outcomes (KDIGO). KDIGO Clinical Guidelines for Acute Kidney Injury. Kidney Int. 2012:2(Supp. 1).