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Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

Sushrut S. Waikar^*, Gary C. Curhan^*, Ron Wald, Ellen P. McCarthy and Glenn M. Chertow

^* Renal Division and Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts, and Division of Nephrology, University of Toronto, Toronto, Ontario, Canada; Division of General Medicine and Primary Care, Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Division of Nephrology, Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California

Address correspondence to: Dr. Sushrut S. Waikar, Channing Laboratory, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115. Phone: 617-525-2740; Fax: 617-525-2008; swaikar{at}partners.org

Received for publication September 29, 2005. Accepted for publication January 15, 2006.

Despite improvements in intensive care and dialysis, some experts have concluded that outcomes associated with acute renal failure (ARF) have not improved significantly over time. ARF was studied in hospitalized patients between 1988 and 2002 using the Nationwide Inpatient Sample, a nationally representative sample of discharges from acute-care, nonfederal hospitals. During a 15-yr period, 5,563,381 discharges with ARF and 598,768 with ARF that required dialysis (ARF-D) were identified. Between 1988 and 2002, the incidence of ARF rose from 61 to 288 per 100,000 population; the incidence of ARF-D increased from 4 to 27 per 100,000 population. Between 1988 and 2002, in-hospital mortality declined steadily in patients with ARF (40.4 to 20.3%; P < 0.001) and in those with ARF-D (41.3 to 28.1%; P < 0.001). Compared with 1988 to 1992, the multivariable-adjusted odds ratio (OR) of death was lower in 1993 to 1997 (ARF: OR 0.62, 95% confidence interval [CI] 0.61 to 0.64; ARF-D: OR 0.63, 95% CI 0.59 to 0.66) and 1998 to 2002 (ARF: OR 0.40, 95% CI 0.39 to 0.41; ARF-D: OR 0.47, 95% CI 0.45 to 0.50). The percentage of patients who had ARF with a Deyo-Charlson comorbidity index of 3 or more increased from 16.4% in 1988 to 26.6% in 2002 (P < 0.001). This study provides evidence from an administrative database that the incidence of ARF and ARF-D is rising. Despite an increase in the degree of comorbidity, in-hospital mortality has declined.

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