Abstract: FR-PO087

AKI in Heart Failure Hospitalizations – National Trends and Outcomes

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Sakhuja, Ankit, Mayo Clinic, Rochester, Minnesota, United States
  • Banaei-Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States
  • Albright, Robert C., Mayo Clinic, Rochester, Minnesota, United States
Background

Heart failure (HF) is an important cause of morbidity and mortality. Dialysis requiring acute kidney injury (AKI-D) is associated with worse outcomes in HF, however, longitudinal trends of AKI-D and its impact on mortality are unclear.

Methods

Using Nationwide/National Inpatient Sample from years 2000-2014, we identified patients with primary discharge diagnosis of HF and those with AKI-D by ICD-9-CM codes. We used linear regression to assess trends of AKI-D and multivariable regression models to estimate adjusted odds of AKI-D and mortality over time. Model for AKI-D was adjusted for patient age, sex, race, payer, admission day, history of peripheral vascular disease, coronary artery disease, hyperlipidemia, stroke, diabetes, chronic kidney disease, hypertension, presence of cardiogenic shock, use of balloon pump, mechanical ventilation, hospital location, teaching status, volume, bed-size and region. Model for mortality was also adjusted for AKI-D and interaction between year and AKI-D.

Results

Of 15,092,707 HF hospitalizations, 149,468 (0.99%) had AKI-D. Patients with AKI-D were <80 years old (77% vs 60.5%; p<0.001), males (55.6% vs 47.8%; p<0.001) and whites (70.5% vs 60.0%; p<0.001). Incidence of AKI-D increased from 0.5% in 2000 to 1.5% in 2014 (p<0.001 for trend). Odds of developing AKI-D steadily increased to nearly 4 times by year 2014 (Fig 1a). Though, odds of mortality due to AKI-D decreased steadily, AKI-D continued to be independently associated with 3.67 times higher mortality even by year 2014 (Fig 1b).

Conclusion

AKI-D is seen in about 1% HF hospitalizations, however, the risk of AKI-D in these admissions on the rise. Though the impact of AKI-D on mortality is decreasing, it is still a significant risk factor for mortality in HF admissions.

Fig1: OR for AKI-D(a) & its impact on mortality(b)