Abstract
BackgroundThere are limited data on acute kidney injury (AKI) complicating acute myocardial infarction with cardiogenic shock (AMI-CS). This study sought to evaluate 15-year national prevalence, temporal trends and outcomes of AKI with no need for hemodialysis (AKI-ND) and requiring hemodialysis (AKI-D) following AMI-CS.MethodsThis was a retrospective cohort study from 2000–2014 from the National Inpatient Sample (20% stratified sample of all community hospitals in the United States). Adult patients (>18 years) admitted with a primary diagnosis of AMI and secondary diagnosis of CS were included. The primary outcome was in-hospital mortality in cohorts with no AKI, AKI-ND, and AKI-D. Secondary outcomes included predictors, resource utilization and disposition.ResultsDuring this 15-year period, 440,257 admissions for AMI-CS were included, with AKI in 155,610 (35.3%) and hemodialysis use in 14,950 (3.4%). Older age, black race, non-private insurance, higher comorbidity, organ failure, and use of cardiac and non-cardiac organ support were associated with the AKI development and hemodialysis use. There was a 2.6-fold higher adjusted risk of developing AKI in 2014 compared to 2000. Presence of AKI-ND and AKI-D was associated with a 1.3 and 1.7-fold higher adjusted risk of mortality. Compared to the cohort without AKI, AKI-ND and AKI-D were associated with longer length of stay (9±10, 12±13, and 18±19 days respectively; p<0.001) and higher hospitalization costs ($101,859±116,204, $159,804±190,766, and $265,875 ± 254,919 respectively; p<0.001).ConclusionAKI-ND and AKI-D are associated with higher in-hospital mortality and resource utilization in AMI-CS.
Highlights
Black race, non-private insurance, higher comorbidity, organ failure, and use of cardiac and non-cardiac organ support were associated with the acute kidney injury (AKI) development and hemodialysis use
In this nationally-representative population of acute myocardial infarction (AMI)-cardiogenic shock (CS), we noted a steady increase in AKI with no need for hemodialysis (AKI-ND) and acute kidney injury requiring dialysis (AKI-D), with 2.6-fold higher adjusted risk of developing AKI in 2014 compared to 2000
Using the Healthcare Cost and Utilization Project (HCUP)-National Inpatient Sample (NIS) database, we have previously demonstrated that single- and multi-organ failure is associated with higher in-hospital mortality and resource utilization in acute myocardial infarction with cardiogenic shock (AMI-CS).[5]
Summary
Acute myocardial infarction (AMI) continues to remain a leading cause of death worldwide, and in patients with concomitant cardiogenic shock (CS), the mortality is nearly 10-times higher.[1,2,3,4,5,6,7,8,9,10,11] In AMI-CS, there is often non-cardiac organ failure–neurological, respiratory, renal, hepatic and hematological. [5, 6, 11,12,13] Acute kidney injury AKI) is a challenging public health epidemic and is associated with high healthcare utilization.[14, 15] AKI with no need for dialysis (AKI-ND) and AKI requiring dialysis (AKI-D) are associated with worse mortality and higher resource utilization in patients with septic shock and smaller studies on AMI. [12, 13, 16,17,18] there are limited large-scale data on the prevalence of AKI-ND and AKI-D in admissions with CS the United States. [5, 6, 11,12,13] Acute kidney injury AKI) is a challenging public health epidemic and is associated with high healthcare utilization.[14, 15] AKI with no need for dialysis (AKI-ND) and AKI requiring dialysis (AKI-D) are associated with worse mortality and higher resource utilization in patients with septic shock and smaller studies on AMI. This study sought to evaluate 15-year national prevalence, temporal trends and outcomes of AKI with no need for hemodialysis (AKI-ND) and requiring hemodialysis (AKI-D) following AMI-CS
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