Trends in Renal Dysfunction, Renal Replacement Therapy, and Mortality in Intensive Care Units: A Nationwide Japanese ICU database study.

BACKGROUND

Renal replacement therapy (RRT) is widely used in critically ill patients with renal dysfunction, yet population-level trends in RRT utilization and associated outcomes remain incompletely characterized. We examined temporal changes in renal dysfunction, RRT use, and hospital mortality in Japanese intensive care units (ICUs).

METHODS

We conducted a retrospective cohort study using the Japanese Intensive Care Patient Database, including adult ICU patients admitted between April 2015 and March 2023. Study periods were defined by fiscal year cohorts (April 2015-March 2018, April 2018-March 2021, and April 2021-March 2023). Multivariable logistic regression with mixed effects was used to evaluate adjusted hospital mortality over time.

RESULTS

A total of 80,255 ICU patients were included. The proportion of patients with renal dysfunction increased modestly over time, whereas overall RRT utilization remained relatively stable across study periods. Adjusted hospital mortality was lower in several later years compared with 2015, although differences between predefined study periods were modest.

CONCLUSIONS

In this nationwide Japanese ICU cohort, RRT use among patients with renal dysfunction changed little over the past decade. Although adjusted mortality was lower in some later years, overall temporal changes were modest. These findings suggest that real-world RRT practice has remained largely stable despite evolving critical care evidence and support continued evaluation of practice patterns and indications for RRT.