High Incidence of Renal Failure Requiring Short‐Term Dialysis: A Narrative Review from 2010 To 2023

Acute kidney injury (AKI) continues affecting millions of hospitalized patients worldwide each year and poses a major public health challenge. Estimates suggest 13.3 million cases of AKI occur annually, with a global incidence of 21.6% among all hospital admissions [1,2]. Even temporary declines in kidney function are linked to worsened outcomes including longer hospital stays, higher readmission rates, and increased mortality [3,4]. Significantly, up to 20% of AKI cases progress to requiring shortterm renal replacement therapy such as dialysis, representing a subset at highest risk [5]. Patients who develop renal failure severe enough to necessitate temporary dialytic support endure prolonged recoveries, higher morbidity and costs approximating $88,000 per episode in the United States [6,7]. With an aging global population and rising rates of co-morbidities like diabetes and hypertension that compromise baseline renal function, the incidence of dialysisrequiring AKI is anticipated to rise proportionally [8,9]. While prompt diagnosis and modern management have improved general AKI care in recent years, targeted prevention strategies to curb progression remain limited [10]. Risk factors for initial AKI onset such as advanced age, reduced baseline kidney function, sepsis, major surgery and nephrotoxic medications are well characterized [11,12].

However, independent predictive factors specifically for those with AKI destined to require short-term renal replacement therapy warrant ongoing clarification to guide evidence-based preventive initiatives [13]. Advances in precision nephrology utilizing electronic health data present opportunities to risk-stratify those most vulnerable to modifiable insults driving worst outcomes [14]. Initial evidence suggests integrated care approaches optimizing judicious nephrotoxin use according to real-time declining kidney function can meaningfully curb dialytic AKI rates [15,16]. However, prospective evaluation of standardized prevention models applied at scale is imperative to establish widespread scalability and impact [17]. By systematically reviewing current literature with a focus on independent drivers amenable to mitigation, this analysis aims to inform development of targeted strategies curbing preventable progression to dialysis-requiring renal failure. With rigorous investigation, optimized acute kidney care best practices may prove generalizable across diverse populations and healthcare systems.

A comprehensive literature search was performed to identify relevant studies published between January 2010 and December 2023. The following electronic databases were searched: PubMed, Embase, CINAHL, and Cochrane Library. Search terms included “acute kidney injury” OR “acute renal failure” AND “dialysis” OR “renal replacement therapy” AND “incidence” OR “epidemiology” OR “outcomes” OR “prevention”. Reference lists of included articles were also manually reviewed to find additional sources. Inclusion criteria were original research studies or review articles discussing epidemiological trends, risk factors, clinical outcomes, or preventive strategies related to acute kidney injury requiring short-term dialytic support among hospitalized patients. Articles were excluded if they exclusively focused on pediatric populations, acute poisoning exposures, or specialized disease cohorts. Non- English articles were excluded due to feasibility constraints. Titles and abstracts of the initial search results were independently reviewed by two reviewers according to the predefined inclusion/ exclusion criteria. Full texts of potentially relevant articles were then assessed, and final selections were made by consensus. Data was extracted on study characteristics, key findings, limitations, and conclusions using a standardized form. A narrative synthesis was performed to summarize and discuss major themes from the included literature (Tables 1-4).

Table 1:Summary of Literature Review.

Table 2:International Trends in Acute Renal Failure due to AKI.

Table 3:Summary of Mortality and Long-term Outcomes in Acute Renal Failure.

Table 4: Summary of AKI Prevention Strategies and Their Outcomes.

This review included 15 original research articles, and 3 review papers published between 2010-2023 analyzing topics related to the epidemiology and outcomes of acute kidney injury progressing to acute renal failure necessitating short-term dialytic support.

Incidence and Trends

All 15 epidemiological studies reported increasing incidence or prevalence trends of renal failure due to AKI over time. The largest retrospective database analysis by Johnson et al. involving over 4 million hospitalized patients in the United States found the rate of acute renal failure rose from 2.0% in 2010 to 3.5% in 2020, representing a 50% relative increase [9]. International studies from Europe, Canada, the UK, Australia and Japan also documented parallel rises between 20-75% according to location and years assessed.

Risk Factors

Eleven studies evaluated risk factors for renal failure among AKI patients. Advanced age over 65, pre-existing chronic kidney disease, and co-morbidities such as diabetes, heart failure and cirrhosis were consistently linked to 2-10 times greater odds of progression in multivariable regression analyses synthesized by Pannu et al. Major surgical procedures, exposure to nephrotoxic drugs including antibiotics, intravenous dye and antifungal, also heightened risk [12].

Outcomes

Twelve included articles reported outcomes data. In-hospital mortality for acute renal failure requiring dialysis ranged from 60- 75%. Post-discharge mortality at 30 days was over 40% on average according to two meta-analyses, and 1-year mortality exceeded 50- 70% in five large observational cohorts. Approximately 40-50% of short-term survivors progressed to end-stage renal disease or died long-term in three studies tracking long-term squealed.

Prevention Strategies

Five articles evaluated potential prevention strategies implemented at single institutions. Antibiotic stewardship programs and computerized intravenous fluid order sets were tied to significant reductions in nephrotoxic exposures and dialysis rates in two U.S. hospitals over 2–3-year periods. Electronic health record tools for early AKI detection and automated nephrology consultation similarly correlated with 20-30% lower renal failure incidence at two medical centers.

The narrative review of the high incidence of renal failure requiring short-term dialysis from 2010 to 2023 reveals a complex and concerning trend in global health. This discussion will synthesize the key findings, explore their implications, and suggest directions for future research and clinical practice.

Rising Incidence

The dramatic increase in the incidence of renal failure requiring short-term dialysis, from approximately 15 per 100,000 populations in 2010 to over 35 per 100,000 in 2023, represents a significant public health challenge. This trend, as visualized in our graph, underscores the growing burden on healthcare systems worldwide.

Several factors contribute to this rising incidence

a) Aging Population: The global demographic shift towards an older population has significant implications for renal health. As Chawla et al. (2017) note, “The aging global population has led to an increase in age-related co-morbidities, which are significant risk factors for AKI and subsequent need for dialysis.” This trend is likely to continue, necessitating targeted interventions for older adults [17].
b) Improved Recognition and Diagnosis: While improved diagnostic criteria have enhanced our ability to detect AKI, it also raises questions about potential over-diagnosis. Kellum and Prowle (2018) suggest that “The implementation of standardized AKI diagnostic criteria, such as KDIGO, has significantly improved our ability to recognize and diagnose AKI at earlier stages [18].
c) Increasing Prevalence of Risk Factors: The global rise in chronic diseases such as diabetes, hypertension, and obesity contributes significantly to the AKI burden. In 2018 a Hoste et al. highlight that the rising global prevalence of diabetes, hypertension, and obesity has contributed to an increased population at risk for AKI and subsequent need for dialysis. This underscores the need for integrated approaches to chronic disease management and AKI prevention [5].
d) Advancements in Critical Care: The paradoxical increase in AKI incidence due to improved critical care survival rates presents a unique challenge. As Ronco et al. (2019) note, “While critical care advancements have improved overall survival, they have also increased the pool of patients at risk for AKI and dialysis requirement.” This highlights the need for tailored AKI prevention strategies in critical care settings [19].

Risk Factors

The identified risk factors provide valuable insights for targeted prevention and early intervention strategies:
a) Pre-existing CKD: The strong association between CKD and AKI progression, as reported by Coca et al. (2018), emphasizes the need for vigilant monitoring and management of CKD patients [20].
b) Advanced Age: The increased risk associated with age, as noted by Grams et al. (2016), calls for age-specific prevention and management strategies. This could include tailored fluid management protocols and medication dosing guidelines for older adults [21].
c) Co-morbidities: The synergistic effect of multiple comorbidities on AKI risk, highlighted by Mehta et al. (2020), underscores the importance of integrated care approaches [22].
d) Sepsis: The persistent role of sepsis as a leading cause of AKI, as reported by Uchino et al. (2015), emphasizes the need for improved sepsis management protocols [23].
e) Major Surgery: The increased risk associated with major surgical procedures, particularly cardiac and vascular surgeries (Goren and Matot, 2015), highlights the importance of perioperative AKI prevention strategies [24].
f) Nephrotoxic Medications: The significant contribution of nephrotoxic medications to AKI cases, as noted by Goldstein et al. (2020), underscores the need for improved medication management strategies. The development and implementation of electronic alert systems and automated pharmacy reviews could potentially reduce nephrotoxic medication exposure [25].

Outcomes

a) The poor outcomes associated with renal failure requiring short-term dialysis highlight the critical need for improved management strategies and long-term care approaches:
b) Short-term Mortality: The high in-hospital mortality rates reported by Uchino et al. (2015) emphasize the need for improved acute management strategies. Research into novel dialysis modalities, timing of initiation, and supportive care approaches could potentially improve short-term outcomes [23].
c) Long-term Mortality: The concerning 1-year mortality rates reported by Coca et al. (2018) underscore the lasting impact of severe AKI episodes [20]. This highlights the need for comprehensive long-term follow-up care for AKI survivors. Future research should focus on identifying risk factors for long-term mortality and evaluating the efficacy of targeted interventions.
d) Renal Recovery: The variable rates of renal recovery and high risk of CKD progression, as noted by Kellum et al. (2017), emphasize the need for long-term monitoring and management of AKI survivors [26]. Research into predictors of renal recovery and interventions to promote renal rehabilitation could potentially improve long-term outcomes.
e) Quality of Life: The significant impact on quality of life and functional status, highlighted by Bagshaw et al. (2021), underscores the need for comprehensive rehabilitation programs for AKI survivors [27].
f) Healthcare Utilization: The increased healthcare utilization and costs associated with AKI requiring dialysis, as reported by Chawla et al. (2017), highlight the economic burden of this condition [17].

In conclusion, this narrative review synthesizing over a decade of evidence implicates consistently modifiable risk factors contributing to progression of AKI severity requiring temporary dialytic support. Accumulated data suggest exposure minimization strategies incorporated into bundled prevention protocols hold potential to meaningfully curb worst outcomes on a discernible population scale. With aging demographics and rising chronic disease worldwide amplifying underlying vulnerabilities, reducing iatrogenic exacerbations through judicious, targeted risk mitigation represents an impactful opportunity for preventive nephrology. While non-modifiable factors shape baseline risks, findings substantiate significantly modulating amplifying influences to protect kidney health as a public health priority. Further exploration optimizing personalized precision approaches is warranted to dissect which mitigations confer most benefit according to individual risk profiles. With rigorous evaluation of scalable implementation models and cost-effectiveness, disseminated best practices may prove generalizable to lower preventable AKI escalation globally. With growing burdens already straining healthcare systems, curtailing the worst consequences of this critical condition deserves urgent attention. With commitment to well-powered investigations, bundled prevention prioritizing modifiable risk control can alleviate immense suffering for vulnerable patients worldwide.

Our review may be subject to publication bias, as studies with positive or significant findings are more likely to be published and included in academic databases. This could potentially overestimate the incidence or severity of AKI progressing to dialysis-dependent renal failure. The 15 original research articles likely employed various study designs, populations, and methodologies. This heterogeneity may limit the comparability of results across studies and make it challenging to draw definitive conclusions. Our review was based on published aggregate data rather than individual patient data. This limits our ability to perform more detailed subgroup analyses or to control for confounding factors consistently across studies. By concentrating on AKI progressing to dialysis-dependent renal failure, our review may not capture the full spectrum of AKI, including less severe forms that may still have significant longterm consequences. This focus could potentially overemphasize the most severe cases at the expense of understanding the broader impact of AKI. Despite efforts to standardize AKI definitions, there may be variations in how AKI was defined across the included studies, particularly in earlier publications. This could affect the comparability of incidence rates and outcomes across studies. In using both original research articles and review papers, there is a possibility of some data being counted multiple times if the same primary studies were included in different reviews. Despite our best efforts to maintain objectivity, the selection and interpretation of studies may have been influenced by the reviewers’ prior knowledge and expectations.

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