Indicator Details: Incidence of Dialysis-requiring AKI in the General Population
Data Sources
 
Stratification and Year Choices:

  Source
  • NIS

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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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The U.S. population incidence of dialysis-requiring AKI increased from 222 cases per million person-years in 2000 to 533 cases per million person-years in 2009, a yearly increase of 10% per year.  The absolute number of cases of dialysis-requiring AKI increased from 63,000 cases in 2000 to almost 164,000 cases in 2009 (Hsu et al., 2013).
Chart Explanation: The U.S. population incidence of dialysis-requiring AKI increased from 222 cases per million person-years in 2000 to 533 cases per million person-years in 2009, a yearly increase of 10% per year. 
The Nationwide Inpatient Sample (NIS) is a U.S. nationally representative administrative database of hospitalizations. The NIS is the largest all-payer publicly available national hospital database containing a 20% stratified sample of all short-term, nonfederal, nonrehabilitation hospitals. Hospitals are sampled according to geographic region, location (urban/rural), teaching status, ownership, and bedside; all discharges from sampled hospitalizations are included in the database. The NIS was developed as a part of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality. (www.hcup-us.ahrq.gov/hcupdatapartners.jsp)

Cases of dialysis-requiring AKI were identified using validated ICD9-CM codes (Waikar et al., 2006). Dialysis-requiring AKI was defined as the presence of any of the following diagnostic codes (in any position): 584.5, 584.6, 584.7, 584.8, or 584.9; and presence of any of the following procedure codes for dialysis (in any position): 39.95, V45.1, V56.0, V56.1. To avoid inclusion of patients admitted for initiation of chronic maintenance dialysis, cases with procedure codes for arteriovenous fistula creation or revision (39.27, 39.43, 39.43, 39.93) were excluded.

The total absolute number of cases of dialysis-requiring AKI for each calendar was estimated using appropriate discharge-level sampling weights to account for the NIS sampling scheme.

The population incidence of dialysis-requiring AKI for each calendar year was estimated by dividing the absolute number of cases by the total population (obtained from the U.S. Census Bureau).
FieldData
Description of MeasurePopulation incidence if dialysis-requiring AKI (cases per million person-years)
Data SourceNationwide Inpatient Sample
Type of Data SourceAdministrative Data
Data SetNationwide Inpatient Sample (NIS), 2000-2009
Health Care System DataNo
Regional or NationalNational
Demographic GroupAll patients hospitalized in U.S. short-term, nonfederal, nonrehabilitation hospitals. 
NumeratorCases of dialysis-requiring AKI
DenominatorU.S. population total
Limitations of IndicatorDialysis-requiring AKI cases were ascertained using diagnostic and procedures codes only without any laboratory or clinical data. Codes did not allow for discrimination between de novo AKI vs. acute on chronic renal disease, and between intermittent vs. continuous renal replacement therapies. Data did not allow for identification of individuals with recurrent episodes of dialysis-requiring AKI.
References and Sources:
  • Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2013;24(1):37-42.
    http://www.ncbi.nlm.nih.gov/pubmed/23222124
  • Waikar SS, Wald R, Chertow GM, et al. Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. J Am Soc Nephrol. 2006;17(6):1688-94.
    http://www.ncbi.nlm.nih.gov/pubmed/16641149
  • HCUP Home. Healthcare Cost and Utilization Project (HCUP). December 2013. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/home.jsp.
    www.hcup-us.ahrq.gov/nisoverview.jsp
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd