Abstract 11743: Impact of Chronic Kidney Disease / End Stage Renal Disease on Aortic Dissection: Results From the Nationwide Readmission Database

Abstract

Introduction: Prior literature has shown that in-hospital and postoperative renal failure are independent mortality predictors in acute aortic dissection (AAD). However, there is limited data on chronic kidney disease (CKD) and end-stage renal disease (ESRD) as pre-existing outcome predictors with AAD Methods: The Nationwide Readmission Database was analyzed from 2016 to 2019 for adult patients admitted with a primary diagnosis of AAD. Patients were assessed for CKD and ESRD. Outcomes were measured for the effect of renal dysfunction on 30-day readmission, inpatient mortality, and length of stay (LOS). Results: Aortic dissection occurred in 45,481 patients over the study period, of which 4727 were readmitted. The mean age was 64 years, and logistical regression analysis revealed that patients with ESRD admitted with AAD were 58% more likely to be readmitted (95% CI [1.29 - 1.93], p<0.001) within 30 days than those without (Figure 1). Notably, ESRD patients had a 30% reduction (95% CI 0.57 - 0.86) in in-patient mortality (Figure 2). Mean LOS was also higher for ESRD patients (6.7 days, 95% CI 5.09 - 8.38) while lower for CKD stage 3-5 (-1.06 days, 95% CI -1.62 --0.50) compared with those without renal disease. Discussion: We observed that patients with ESRD and AAD have higher readmission rates and LOS. However, decreased mortality rates compared with patients with CKD stages 3-5 were observed that could be attributed to increased exposure to healthcare interventions secondary to frequent hemodialysis follow-ups, compared with CKD stages 3-5. Early stages of CKD were excluded, given the possibility of a lack of coding in electronic medical records.