Deadly ignorance

By John Pickering 14/12/2012 4

How many deaths does it take?  We hear that question asked time and again following a tragic event.  We also hear it with calls for changes to our public health priorities.  Well, I am now asking it with respect to Acute Kidney Injury.

  • Acute Kidney Injury (AKI) is one of the most common hospital events (4-5% of patients get it).
  • The most severe forms of AKI result in emergency dialysis.
  • Research out of the US has shown that there has been a doubling of dialysis for AKI over the past decade (1).
  • Now there are 533 cases of dialysis requiring AKI per million people each year in the US.*
  • 24% of those needing dialysis died in hospital
  • About 10 times the number who need dialysis actually get AKI.
  • Even mild AKI raises the risk of in-hospital death and long term kidney problems.
  • More people each year now have dialysis for AKI than those who start dialysis as a result of a chronic kidney disease.

Comparative New Zealand statistics

I would like to do them but have had problems getting funding.  I especially want to look to see if there are any ethnic biases in the numbers.

If we take the US numbers and apply them to our population of 4.4 Million then there would be:

  • 2350 cases of dialysis-requiring AKI of whom 564 would die.
  • Over 20,000 people each year would have AKI.  Many more than 564 would die.

My gut reaction based on the use of dialysis in the Christchurch hospital intensive care unit is that 2350 is probably too high, maybe two to four times too high.  This may reflect differences in dialysis protocols and admittance to ICU.  It is less likely to reflect a lower incidence of AKI.  My best guestimates are:

  • 4000 to 8000 cases of AKI each year with 400 to 800+ deaths.

These numbers are greater than the road toll – another acute event.

They are comparable with Breast Cancer**.

I would like them not to be guestimates.

Maybe the funding will come next year.

The good news

My research and others over the past few years has:

  • identified new biological markers of injury to the kidney
  • assessed many of these and determined that they are of clinical value
  • come up with better ways of defining the disease
  • determined that some pre-existing tools can be applied in slightly different ways to give early warning of changes in kidney function
  • come up with some promising interventions which may reduce the risk of developing AKI

Here endeth the 2012 report.


1.  Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu C-Y. Temporal Changes in Incidence of Dialysis-Requiring AKI. J Am Soc Nephrol 2012; Online ahead of print.

* the data was expressed in “million-person-years” but as the data was for one year then it is OK to express it as per million people.

**The difference between AKI and many other diseases is that while AKI causes death it is almost always secondary to another event – heart attack, severe infection, cardiac surgery etc, so it is rarely recorded as THE cause of death.

Tagged: Acute Kidney Injury, AKI, Kidney, Mortality, Nephrolog

4 Responses to “Deadly ignorance”

  • John – Your opening line “how many deaths does it take?” invites the response “well, we all have to die of something”. Having more freely available dialysis won’t make us all immortal. In any event, the notion that using dialysis for AKI will save lives seems doubtful in the light of your comment that AKI “is almost always secondary to another event – heart attack, severe infection, cardiac surgery etc”. This seems to indicate that all dialysis will do is keep the affected patients alive but with severely impaired health for a bit longer. Surely that’s just dragging out the misery for them and their families, and spending precious health dollars in a not very cost effective way?

  • >keep the affected patients alive but with severely impaired health for a bit longer.

    The actual patient may very well be quite happy about still being alive. Cost effectiveness can be measured using a QALY calculation.

  • Hi lynley,
    No it does not work that way. ~50 to 80% of those receivng dialysis survive. Without it they all would have died within a day or two. Note, the majority of the dialysis is only for a few days. Only very occasionally do they go on to needing permanent dialysis.
    Note, in AKI dialysis “buys time” for the kidney’s to recover. In Cardiac Arrests, for example, it is normally only given after 2 or 3 days (because AKI takes so long to detect) by which time the patients hearts are well on the way to recovery and doctors have assessed brain function as OK.

  • another thought Lynley. Some of my research involves trying to predict the likelihood of death/recovery based on urinary biomarkers of kidney injury. In thefuture I hope this will help doctors and families to better decide whether it is worthwhile to dialysis or oter interventions.

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