Abstract 19022: Is Peritoneal Dialysis Superior to Hemodialysis Regarding Outcomes in End-Stage Renal Disease Patients With ST-Segment Elevation Myocardial Infarction? Insights From the National Inpatient Sample Database (2016-2020)

Abstract

Introduction: ST-segment elevation myocardial infarction (STEMI) in end-stage renal disease (ESRD) is associated with worse outcomes. Peritoneal dialysis (PD) has shown better hemodynamic tolerability and quality of life. We analyzed outcomes comparing PD to HD in ESRD patients with STEMI using the National Inpatient Sample (NIS) database. Methods: NIS (2016-2020) was queried to identify adult STEMI admissions with co-morbid dialysis-dependent ESRD using ICD-10-CM codes, then stratified to HD-ESRD and PD-ESRD using ICD-10-PCS codes. Propensity score matched HD-ESRD controls were derived based on demographics and baseline co-morbidities. Multivariate logistic/linear regression were used to analyze the outcomes, such as inpatient mortality and complications, length of stay (LOS) and total hospital charge (THC). Results: Of the ESRD patients with STEMI, 1225 underwent PD, and 10675 underwent HD. Trend analysis showed declining in-patient mortality despite increasing STEMI burden in HD group, with up-trending mean LOS and THC. In contrast, PD group showed unchanging trends. Upon propensity score matching, PD patients showed similar adjusted odds of inpatient mortality and mean LOS but significantly lower mean THC. Further, PD patients had lower adjusted odds of inpatient complications, mainly ischemic strokes, pulmonary embolism, and hemopericardium. Conclusions: Our analysis showed a declining trend in inpatient mortality with STEMI in HD group. Although propensity-matching showed similar inpatient mortality, our research deemed PD superior to HD in STEMI patients, given lower financial burden and better outcomes with lower odds of inpatient complications.