S0235 Effect of Chronic Kidney Disease on Short-Term Morbidity and Mortality in Patients With Colon Ischemia

Abstract

INTRODUCTION: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are recognized independent risk factors of colectomy, recurrence, sepsis, and mortality in patients with colon ischemia (CI). Previous research has been limited by small numbers of study patients and lack of data on comorbidities and analyses by stages of CKD. Using a large database of CI patients, we aimed to determine the impact of CKD by stage on short-term morbidity (hospitalization stay, surgical intervention, and 30-day readmission) and short-term mortality (30-day and 90-day mortality) to improve clinical insights in treating CI. METHODS: We conducted a retrospective study using a database of hospitalized patients with CI at Montefiore Medical Center and Yale-New Haven Hospital from 2012 to 2018. Consecutive patients with biopsy-proven CI were identified and included if CKD data were available. Patients were categorized into five CKD stages (CKD 1, Glomerular Filtration Rate [GFR] ≥90 ml/min; CKD 2, GFR 60–90 ml/min; CKD 3, GFR 30–60 ml/min; CKD 4, GFR 30–15 ml/min; and CKD 5, GFR < 15 ml/min). Bivariate, multivariate, and survival analyses assessed potential predictors of morbidity and mortality. RESULTS: 650 patients met inclusion criteria (Table 1). In Table 2, CKD 5 had the longest hospitalization stay (median 9 days, IQR 4–32, P < 0.001) and the highest incidence of surgical intervention (30.8%, P < 0.01) and 30-day readmission (32.5%, P < 0.001) compared to other CKD stages. In multivariate analyses: CKD overall (P = 0.01) and peripheral vascular disease (PVD; OR = 3.05, P < 0.01) independently predicted surgical intervention. CKD overall (P = 0.001), coronary artery disease (OR = 2.33, P < 0.001) and PVD (OR = 2.54, P = 0.02) independently predicted readmission. Male sex (OR = 3.43, P < 0.01), PVD (OR = 3.18, P = 0.04), and surgical intervention (OR = 6.53, P < 0.001) independently predicted 30-day mortality. In a survival analysis, male sex (HR = 2.15, P = 0.01) and surgical intervention (HR = 3.04, P < 0.001) predicted 90-day mortality. CKD overall did not predict 30-day or 90-day mortality in multivariate analyses (Figure 1). CONCLUSION: In CI patients, CKD overall predicted short-term morbidity, namely surgical intervention and 30-day readmission, but did not predict short-term mortality independent of other patient characteristics. CKD 5 had the worst outcomes overall, although there was no stepwise increase in adverse outcomes by increasing CKD stage.Table 1.: Patient CharacteristicsTable 2.: Outcomes by CKD StageFigure 1.: Kaplan-Meier survival curves comparing CKD stages.