National Trends and Outcomes in Dialysis-Requiring Acute Kidney Injury in Heart Failure: 2002-2013.
J Card Fail. 2018 May 03;:
Authors: Correa A, Patel A, Chauhan K, Shah H, Saha A, Dave M, Poojary P, Mishra A, Annapureddy N, Dalal S, Konstantinidis I, Nimma R, Agarwal SK, Chan L, Nadkarni G, Pinney S
BACKGROUND: Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.
METHODS: We used the Nationwide Inpatient Sample (2002-2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS) and cost. We calculated adjusted odds ratios (aOR) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).
RESULTS: We identified 11,205,743 HF hospitalizations. Across 2002-2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male gender, younger age, African-American and Hispanic race, as well as various comorbidities and procedures like sepsis and mechanical ventilation to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR: 2.49; 95% CI: 2.36-2.63; p<0.01) and adverse discharge (aOR: 2.04; 95% CI: 1.95-2.13; p<0.01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002-2013. LoS and cost also decreased across this period.
CONCLUSIONS: The incidence of D-AKI in HF hospitalizations doubled across 2002-2013. Despite declining in-hospital mortality, LoS and cost, D-AKI was associated with worse outcomes.
PMID: 29730235 [PubMed - as supplied by publisher]