RATIONALE & OBJECTIVE Dialysis-requiring acute kidney injury (AKI-D) has increased substantially in the United States. We examined trends in and comorbid conditions associated with hospitalizations and in-hospital mortality in the setting of AKI-D among people with versus without diabetes. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Nationally representative data from the National Inpatient Sample and National Health Interview Survey were used to generate 16 cross-sectional samples of US adults (aged ≥18 years) between 2000 and 2015. EXPOSURE Diabetes, defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. OUTCOME AKI-D, defined using ICD-9-CM diagnosis and procedure codes. ANALYTICAL APPROACH Annual age-standardized rates of AKI-D and AKI-D mortality were calculated for adults with and without diabetes, by age and sex. Data were weighted to be representative of the US noninstitutionalized population. Trends were assessed using join point regression with annual percent change (Δ/y) reported. RESULTS In adults with diabetes, AKI-D increased between 2000 and 2015 (from 26.4 to 41.1 per 100,000 persons; Δ/y, 3.3%; P < 0.001), with relative increases greater in younger versus older adults. In adults without diabetes, AKI-D increased between 2000 and 2009 (from 4.8 to 8.7; Δ/y, 6.5%; P < 0.001) and then plateaued. AKI-D mortality significantly declined in people with and without diabetes. In adults with and without diabetes, the proportion of AKI-D hospitalizations with liver, rheumatic, and kidney disease comorbid conditions increased between 2000 and 2015, while the proportion of most cardiovascular comorbid conditions decreased. LIMITATIONS Lack of laboratory data to corroborate AKI diagnosis; National Inpatient Sample data are hospital-level rather than person-level data; no data for type of diabetes; residual unmeasured confounding. CONCLUSIONS Hospitalization rates for AKI-D have increased considerably while mortality has decreased in adults with and without diabetes. Hospitalization rates for AKI-D remain substantially higher in adults with diabetes. Greater AKI risk-factor mitigation is needed, especially in young adults with diabetes.

中文翻译：

---

美国糖尿病患者与非糖尿病患者因需要透析的急性肾损伤住院的趋势。


理由和目标 在美国，需要透析的急性肾损伤 (AKI-D) 大幅增加。我们研究了 AKI-D 患者与非糖尿病患者中与住院治疗和院内死亡率相关的趋势和合并症。研究设计 横断面研究。背景和参与者 使用来自全国住院患者样本和全国健康访谈调查的全国代表性数据生成 2000 年至 2015 年间美国成年人（年龄≥18 岁）的 16 个横断面样本。 暴露 糖尿病，使用国际疾病分类第九版定义修订，临床修改（ICD-9-CM）诊断代码。结果 AKI-D，使用 ICD-9-CM 诊断和程序代码定义。分析方法 按年龄和性别计算患有和不患有糖尿病的成年人的年度 AKI-D 年龄标准化率和 AKI-D 死亡率。数据经过加权以代表美国非机构化人口。使用连接点回归评估趋势并报告年度百分比变化 (Δ/y)。结果 在成人糖尿病患者中，AKI-D 在 2000 年至 2015 年间有所增加（从每 10 万人 26.4 人增加到 41.1 人；Δ/y，3.3%；P < 0.001），年轻人的相对增加幅度高于老年人。在没有糖尿病的成年人中，AKI-D 在 2000 年至 2009 年间有所增加（从 4.8 增至 8.7；Δ/y，6.5%；P < 0.001），然后趋于稳定。无论是否患有糖尿病，AKI-D 死亡率均显着下降。在患有和不患有糖尿病的成年人中，2000年至2015年间，因肝脏、风湿和肾脏疾病合并症而住院的AKI-D比例有所增加，而大多数心血管合并症的比例有所下降。 局限性 缺乏实验室数据来证实 AKI 诊断；全国住院患者样本数据是医院层面而非个人层面的数据；没有糖尿病类型的数据；残留的未测量的混杂因素。结论 患有或不患有糖尿病的成人中，AKI-D 的住院率显着增加，而死亡率则有所下降。成人糖尿病患者因 AKI-D 住院率仍然较高。需要更大程度地缓解 AKI 风险因素，特别是对于患有糖尿病的年轻人。