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Acute kidney injury in the UK: A replication cohort study of the variation across three regional populations

Acute kidney injury in the UK: A replication cohort study of the variation across three regional populations
Acute kidney injury in the UK: A replication cohort study of the variation across three regional populations
Objectives A rapid growth in the reported rates of acute kidney injury (AKI) has led to calls for greater attention and greater resources for improving care. However, the reported incidence of AKI also varies more than tenfold between previous studies. Some of this variation is likely to stem from methodological heterogeneity. This study explores the extent of cross-population variation in AKI incidence after minimising heterogeneity. Design Population-based cohort study analysing data from electronic health records from three regions in the UK through shared analysis code and harmonised methodology. Setting Three populations from Scotland, Wales and England covering three time periods: Grampian 2003, 2007 and 2012; Swansea 2007; and Salford 2012. Participants All residents in each region, aged 15 years or older. Main outcome measures Population incidence of AKI and AKI phenotype (severity, recovery, recurrence). Determined using shared biochemistry-based AKI episode code and standardised by age and sex. Results Respectively, crude AKI rates (per 10 000/year) were 131, 138, 139, 151 and 124 (p=0.095), and after standardisation for age and sex: 147, 151, 146, 146 and 142 (p=0.257) for Grampian 2003, 2007 and 2012; Swansea 2007; and Salford 2012. The pattern of variation in crude rates was robust to any modifications of the AKI definition. Across all populations and time periods, AKI rates increased substantially with age from ∼20 to ∼550 per 10 000/year among those aged <40 and ≥70 years. Conclusion When harmonised methods are used and age and sex differences are accounted for, a similar high burden of AKI is consistently observed across different populations and time periods (∼150 per 10 000/year). There are particularly high rates of AKI among older people. Policy-makers should be careful not draw simplistic assumptions about variation in AKI rates based on comparisons that are not rigorous in methodological terms.
2044-6055
e019435
Sawhney, Simon
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Robinson, Heather A.
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van der Veer, Sabine
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Hounkpatin, Hilda
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Scale, Tim
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Chess, James
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Peek, Niels
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Marks, Angharad
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Davies, Gareth I.
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Fraccaro, Paolo
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Johnson, Matthew
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Lyons, Ronan A.
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Nitsch, Dorothea
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Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Halbesma, Nynke
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Miller-Hodges, Eve
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Black, Corri
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Fraser, Simon
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Sawhney, Simon
f1117f11-d5fd-4c2b-8bcc-6943d8f529d7
Robinson, Heather A.
9d2b90d4-fd64-4694-9139-04bc94b9648e
van der Veer, Sabine
42cacbef-3400-40e6-bcc2-ffc635e4602a
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Scale, Tim
17116597-d021-4b49-b84e-e730bf6c9db7
Chess, James
232be07e-8c60-465a-a90e-af53c901a8c9
Peek, Niels
3371d9fc-7453-4578-8d3b-c669536ede80
Marks, Angharad
5ba76546-8d85-4393-8d59-d3a177226cd8
Davies, Gareth I.
effd5516-650c-4ca3-a3b7-053181e2acc4
Fraccaro, Paolo
458dead8-3f4a-44e4-88ea-b54c3e594e05
Johnson, Matthew
bbafbaf0-dd02-4348-a2e5-8042ff22d0ed
Lyons, Ronan A.
7e2b5912-18d1-4019-8091-5c9fc98f1a12
Nitsch, Dorothea
154b7a47-f777-4daa-b984-37447a6ad886
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Halbesma, Nynke
1e57bee8-4595-4453-9bb0-49129f43f8f8
Miller-Hodges, Eve
7835e172-49fb-4d21-a543-70401a826f4e
Black, Corri
2dd88049-95f0-484b-8aa0-878e8f52bf0e
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc

Sawhney, Simon, Robinson, Heather A., van der Veer, Sabine, Hounkpatin, Hilda, Scale, Tim, Chess, James, Peek, Niels, Marks, Angharad, Davies, Gareth I., Fraccaro, Paolo, Johnson, Matthew, Lyons, Ronan A., Nitsch, Dorothea, Roderick, Paul, Halbesma, Nynke, Miller-Hodges, Eve, Black, Corri and Fraser, Simon (2018) Acute kidney injury in the UK: A replication cohort study of the variation across three regional populations. BMJ Open, 8 (6), e019435. (doi:10.1136/bmjopen-2017-019435).

Record type: Article

Abstract

Objectives A rapid growth in the reported rates of acute kidney injury (AKI) has led to calls for greater attention and greater resources for improving care. However, the reported incidence of AKI also varies more than tenfold between previous studies. Some of this variation is likely to stem from methodological heterogeneity. This study explores the extent of cross-population variation in AKI incidence after minimising heterogeneity. Design Population-based cohort study analysing data from electronic health records from three regions in the UK through shared analysis code and harmonised methodology. Setting Three populations from Scotland, Wales and England covering three time periods: Grampian 2003, 2007 and 2012; Swansea 2007; and Salford 2012. Participants All residents in each region, aged 15 years or older. Main outcome measures Population incidence of AKI and AKI phenotype (severity, recovery, recurrence). Determined using shared biochemistry-based AKI episode code and standardised by age and sex. Results Respectively, crude AKI rates (per 10 000/year) were 131, 138, 139, 151 and 124 (p=0.095), and after standardisation for age and sex: 147, 151, 146, 146 and 142 (p=0.257) for Grampian 2003, 2007 and 2012; Swansea 2007; and Salford 2012. The pattern of variation in crude rates was robust to any modifications of the AKI definition. Across all populations and time periods, AKI rates increased substantially with age from ∼20 to ∼550 per 10 000/year among those aged <40 and ≥70 years. Conclusion When harmonised methods are used and age and sex differences are accounted for, a similar high burden of AKI is consistently observed across different populations and time periods (∼150 per 10 000/year). There are particularly high rates of AKI among older people. Policy-makers should be careful not draw simplistic assumptions about variation in AKI rates based on comparisons that are not rigorous in methodological terms.

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Accepted/In Press date: 16 May 2018
e-pub ahead of print date: 30 June 2018
Published date: 30 June 2018

Identifiers

Local EPrints ID: 421013
URI: http://eprints.soton.ac.uk/id/eprint/421013
ISSN: 2044-6055
PURE UUID: 02252130-da23-4d3f-af0d-8c5096f112c4
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406

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Date deposited: 21 May 2018 16:30
Last modified: 27 Jan 2020 13:42

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