Abstract
Background
Examining regional variation in acute kidney injury (AKI) and associated outcomes may reveal inequalities and possibilities for optimization of the quality of care. Using the Danish medical databases, we examined regional variation in the incidence, follow-up, and prognosis of AKI in Denmark.
Methods
Patients with one or more AKI episodes in 2017 were identified using population-based creatinine measurements covering all Danish residents. Crude and sex-and-age-standardized incidence rates of AKI were estimated using census statistics for each municipality. Adjusted hazard ratios (aHR) of chronic kidney disease (CKD), all-cause death, biochemical follow-up, and outpatient contact with a nephrology department after AKI were estimated across in geographical regions and categories of municipalities, accounting for differences in demographics, comorbidities, medication use, lifestyle and social factors, and
baseline kidney function.
Results
We identified 63,382 AKI episodes in 58,356 adults in 2017. The regional standardized AKI incidence rates ranged from 12.9 to 14.9 per 1,000 person-years. Compared with the Capital Region of Denmark, the aHRs across regions ranged from 1.04 to 1.25 for CKD, from 0.97 to 1.04 for all-cause death, from 1.09 to 1.15 for biochemical follow-up, and from 1.08 to 1.49 for outpatient contact with a nephrology department after AKI. Similar variations were found across municipality categories.
Conclusions
Within the uniform Danish healthcare system, we found modest regional variation in AKI incidence. The mortality after AKI was similar; however, CKD, biochemical follow-up, and nephrology follow-up after AKI varied across regions and municipality categories
Examining regional variation in acute kidney injury (AKI) and associated outcomes may reveal inequalities and possibilities for optimization of the quality of care. Using the Danish medical databases, we examined regional variation in the incidence, follow-up, and prognosis of AKI in Denmark.
Methods
Patients with one or more AKI episodes in 2017 were identified using population-based creatinine measurements covering all Danish residents. Crude and sex-and-age-standardized incidence rates of AKI were estimated using census statistics for each municipality. Adjusted hazard ratios (aHR) of chronic kidney disease (CKD), all-cause death, biochemical follow-up, and outpatient contact with a nephrology department after AKI were estimated across in geographical regions and categories of municipalities, accounting for differences in demographics, comorbidities, medication use, lifestyle and social factors, and
baseline kidney function.
Results
We identified 63,382 AKI episodes in 58,356 adults in 2017. The regional standardized AKI incidence rates ranged from 12.9 to 14.9 per 1,000 person-years. Compared with the Capital Region of Denmark, the aHRs across regions ranged from 1.04 to 1.25 for CKD, from 0.97 to 1.04 for all-cause death, from 1.09 to 1.15 for biochemical follow-up, and from 1.08 to 1.49 for outpatient contact with a nephrology department after AKI. Similar variations were found across municipality categories.
Conclusions
Within the uniform Danish healthcare system, we found modest regional variation in AKI incidence. The mortality after AKI was similar; however, CKD, biochemical follow-up, and nephrology follow-up after AKI varied across regions and municipality categories
| Original language | English |
|---|---|
| Journal | Nephrology Dialysis Transplantation |
| Early online date | 22 Dec 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 22 Dec 2023 |
Bibliographical note
AcknowledgementsS.S. was supported by a Starter Grant for Clinical Lecturers from the Academy of Medical Sciences, Wellcome Trust, Medical Research Council, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK [SGL020\1076].
Funding
The study was funded by Aarhus University, the A.P. Møller Foundation (grant number 19-L-0332), the Health Research Foundation of the Central Denmark Region, and the Independent Research Fund Denmark (grant number 0134-00407B). The funding sources played no role at any stage of the study
Data Availability Statement
The data underlying this article cannot be shared according to Danish law. Requests from researchers at certified Danish research institutions to access the databases used in this study may be emailed to the Danish Health Data Authority (forskerservice@sundhedsdata.dk).Keywords
- Acute kidney injury
- Chronic Kidney Disease
- Incidence
- Prognosis
- Variation