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Die Herausforderung akute Nierenschädigung

Querschnittsstudie zu Prävalenz und Kosten auf einer universitären Intensivstation

The challenge of acute kidney injury

Cross-sectional study on prevalence and costs in a university intensive care unit

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Zusammenfassung

Hintergrund und Zielsetzung

Die akute Nierenschädigung [„acute kidney injury“ (AKI)] stellt eine häufige und schwerwiegende Komplikation bei kritisch kranken Patienten dar. Aktuelle Daten zur Prävalenz und den resultierenden Kosten der AKI sowie eine Übersicht zu den häufigsten AKI-assoziierten Diagnosen auf deutschen Intensivstationen fehlen.

Material und Methoden

Es wurden alle erwachsenen Patienten (> 18 Jahre) auf den 5 Intensivstationen des Universitätsklinikums Regensburg (UKR; 78 Betten) mit einer codierten AKI im Zeitraum vom 1.1.2011 bis 31.12.2013 retrospektiv analysiert. Die Diagnosis-Related-Group(DRG)-relevanten Hauptdiagnosen mit der häufigsten AKI-Assoziation wurden ermittelt und die resultierende mittlere Verweildauer sowie die Sollkosten verglichen.

Ergebnisse

Bei insgesamt 891 Patienten wurde die Diagnose AKI verschlüsselt [International Statistical Classification of Diseases (ICD-10)]. Ein akutes respiratorisches Versagen („acute respiratory distress syndrome“), Myokardinfarkt und Sepsis waren die 3 häufigsten mit einer AKI assoziierten DRG-relevanten Hauptdiagnosen. Insgesamt 1103 Patienten wurden mit einer der 3 o. g. Hauptdiagnosen auf den Intensivstationen des UKR behandelt. 249 Patienten (22,6 %) entwickelten eine AKI. Patienten mit AKI zeigten eine signifikant längere Intensiv- und Krankenhausverweildauer als Patienten ohne AKI (18,6 vs. 5,1 Tage und 23,8 vs. 10,4 Tage; p < 0,001). Das Auftreten einer AKI in diesen 3 Patientengruppen war im Jahr 2013 mit Behandlungsmehrkosten in Höhe von 2.019.120,42 € verbunden.

Schlussfolgerung

Die AKI bei Intensivpatienten stellt ein schwerwiegendes medizinisches und sozioökonomisches Problem dar. Das koordinierte Vorgehen mit der Gründung eines nationalen AKI-Netzwerks zur Implementierung evidenzbasierter Therapien, die konsequente Früherkennung von AKI-Risikopatienten und eine intensivierte Suche nach neuen Therapieoptionen könnten die zukünftigen Schritte zur Reduktion der AKI-Inzidenz bzw. -Schwere und der Behandlungsmehrkosten darstellen.

Abstract

Background and objectives

The prognosis of intensive care patients with acute kidney injury (AKI), which is associated with increased mortality is still poor. Current data on the prevalence and the resulting costs of AKI and an overview of the most common diagnoses associated with AKI in German intensive care units (ICU) are lacking.

Patients and methods

In this retrospective study all adult admissions (> 18 Jahre) in the five ICUs at the University Clinic Regensburg (in total 78 beds) from1 January 2011 to 31 December 2013 were evaluated. The ICU diagnoses commonly associated with AKI were identified using the international classification of diseases 10 (ICD 10). The length of ICU and hospital stays and AKI-associated hospital costs in the diagnosis-related groups (DRG) based reimbursement system were compared.

Results

A total of 891 ICU patients with AKI were classified according to the ICD 10 code. Acute respiratory distress syndrome (ARDS), myocardial infarction (MI) and sepsis were the three most common ICU conditions associated with AKI. A total of 1103 patients were admitted with 1 of these 3 main diagnoses and 249 (22.6 %) of these patients developed AKI. Patients with AKI had significantly longer mean ICU and hospital stays compared to patients without AKI (18.6 vs 5.1 days and 23.8 vs. 10.4 days, respectively, p < 0.001). The presence of AKI in critically ill patients with ARDS, MI and sepsis resulted in additional costs of 2,019,120.42 € at the University Hospital of Regensburg in 2013.

Conclusion

Acute kidney injury in critically ill patients represents a significant medical and socioeconomic burden. Early recognition of patients at risk, coordinated research into novel interventions and establishment of the National Acute Kidney Injury Network for implementation of evidence-based therapies may be the next steps to decrease the incidence and severity of AKI and save costs for the national healthcare system.

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Authors and Affiliations

  1. Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    I. Göcze, K. Thelen & H.J. Schlitt

  2. Abteilung für Nephrologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    T. Bergler & B. Banas

  3. Unternehmensentwicklung, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    E. Bossauer & W. Gnann

  4. Zentrum für klinische Studien, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    F. Zeman

  5. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    B.M. Graf & T. Bein

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  1. I. Göcze
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Correspondence to I. Göcze.

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Interessenkonflikt

I. Göcze, T. Bergler, E. Bossauer, F. Zeman, K. Thelen, B.M. Graf, B. Banas, H.J. Schlitt, W. Gnann und T. Bein geben an, dass kein Interessenkonflikt besteht.

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Göcze, I., Bergler, T., Bossauer, E. et al. Die Herausforderung akute Nierenschädigung. Med Klin Intensivmed Notfmed 111, 501–507 (2016). https://doi.org/10.1007/s00063-015-0093-0

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