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This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2005060668v1 17/4/1135    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Xue, J. L. Articles by Collins, A. J. Search for Related Content PubMed PubMed Citation Articles by Xue, J. L. Articles by Collins, A. J. Related Collections Related Article

Incidence and Mortality of Acute Renal Failure in Medicare Beneficiaries, 1992 to 2001

Jay L. Xue^*, Frank Daniels^*, Robert A. Star, Paul L. Kimmel, Paul W. Eggers, Bruce A. Molitoris, Jonathan Himmelfarb and Allan J. Collins^*

^* United States Renal Data System Coordinating Center and Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana; and Division of Nephrology, Maine Medical Center, Portland, Maine

Address correspondence to: Dr. Jay L. Xue, United States Renal Data System, 914 South 8th Street, Suite D-206, Minneapolis, MN 55404. Phone: 612-337-8979; Fax: 612-347-5878; jxue{at}usrds.org

Received for publication June 28, 2005. Accepted for publication January 15, 2006.

This study’s objective was to determine the incidence and mortality of acute renal failure (ARF) in Medicare beneficiaries. Data were from hospitalized Medicare beneficiaries (5,403,015 discharges) between 1992 and 2001 from the 5% sample of Medicare claims. For 1992 to 2001, the overall incidence rate of ARF was 23.8 cases per 1000 discharges, with rates increasing by approximately 11% per year. Older age, male gender, and black race were strongly associated (P < 0.0001) with ARF. The overall in-hospital death rate was 4.6% in discharges without ARF, 15.2% in discharges with ARF coded as the principal diagnosis, and 32.6% in discharges with ARF as a secondary diagnosis. In-hospital death rates were 32.9% in discharges with ARF that required renal dialysis and 27.5% in those with ARF that did not require dialysis. Death within 90 d after hospital admission was 13.1% in discharges without ARF, 34.5% in discharges with ARF coded as the principal diagnosis, and 48.6% in discharges with ARF as a secondary diagnosis. Discharges with ARF were more (P < 0.0001) likely to have intensive care and other acute organ dysfunction than those without ARF. For discharges both with and without ARF, rates for death within 90 d after hospital admission showed a declining trend. In conclusion, the incidence rate of ARF in Medicare beneficiaries has been increasing. Those of older age, male gender, and black race are more likely to have ARF. These data show ARF to be a major contributor to morbidity and mortality in hospitalized patients.

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