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The Burden of Dialysis-Requiring Acute Kidney Injury among Hospitalized Adults with HIV Infection: A Nationwide Inpatient Sample Analysis #MMPMID26125139
AIDS 2015[Jun]; 29 (9): 1061-6 PMID26125139show ga
Objective: To describe the incidence of acute kidney injury (AKI) requiring renal replacement therapy (?dialysis-requiring AKI?) and the impact on in-hospital mortality among hospitalized adults with HIV infection. Design: Longitudinal analysis of a nationally representative administrative database. Methods: We reviewed the Healthcare Cost and Utilization Project?s Nationwide Inpatient Sample Database, a large, nationally representative sample of inpatient hospital admissions, to identify all adult hospitalizations with an associated diagnosis of HIV infection from 2002?2010. We analyzed temporal trends in the incidence of dialysis-requiring AKI and the associated odds of in-hospital mortality. We also explored potential reasons behind temporal changes. Results: Among 1830041 hospitalizations with an associated diagnosis of HIV infection, the proportion complicated by dialysis-requiring AKI increased from 0.7% in 2002 to 1.35% in 2010. This temporal rise was completely explained by changes in demographics and increase in concurrent comorbidities and procedure utilization. The adjusted odds of in-hospital mortality associated with dialysis-requiring AKI also increased over the study period, from 1.45 (95% CI 0.97?2.12) in 2002 to 2.64 (95% CI 2.04?3.42) in 2010. Conclusions: These data suggest that the incidence of dialysis-requiring AKI among hospitalized adults with HIV infection continues to increase, and that severe AKI remains a significant predictor of in-hospital mortality in this population. The increased incidence of dialysis-requiring AKI was largely explained by aging of the HIV population and increasing prevalence of chronic non-AIDS comorbidities, suggesting that these trends will continue.