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Kidney Week

Abstract: SA-PO527

Differences in Cardiovascular and Renal Complication Rates in Thrombotic Microangiopathies with and Without Hemolytic Uremic Syndromes

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Gupta, Sanjeev, Westchester county medical center, White Plains, New York, United States
  • Yandrapalli, Srikanth, Westchester Medical Center, Valhala, New York, United States
  • Chugh, Savneek S., New York Medical College, Hartsdale, New York, United States
Background

Pathophysiologic differences between different thrombotic microangiopathies (TMAs) might predispose to varying complications. We sought to study if there is a difference in the incidence of cardiovascular and renal complications between hemolytic uremic syndrome (HUS)-TMA and non-HUS TMAs.

Methods

We queried the United States National Inpatient Sample years 2005 to 2014 to identify hospitalizations in adult patients (age≥18 years) complicated by either HUS-TMA or non-HUS TMA using ICD-9 codes 283.11 (HUS) and 446.6 (TMA). In this cohort, we analyzed differences in the rates of acute myocardial infarction (AMI), heart failure (HF), stroke or transient ischemic attack (TIA), acute kidney injury (AKI), plasmapheresis and hemodialysis requirement, and in-hospital mortality.

Results

Out the weighted 59,166 cases in our study (mean patient age 50 years, 64% women), HUS-TMA was present in 24.5% (N=14,508) and non-HUS TMA in 75.5% (N=44,658). Patients with non-HUS TMA were older than those with HUS-TMA (mean age 50 years vs 48 years, p<0.001) but had similar gender distribution (women: 64.5% vs 62.9%, p=0.171). Compared to HUS-TMA, non-HUS TMA had higher rates of AMI (5.3% vs 4.2%, p=0.017), stroke/TIA (8.2% vs 3.0%, p<0.001), and plasmapheresis use (39.2% vs 30.9%, p<0.001). Compared to non-HUS TMA, HUS-TMA had higher rates of AKI (58.2% vs 36.4%, p<0.001), CHF (15.7% vs 12.5%, p<0.001), and HD requirement (41.6% vs 16.7%, p<0.001). In-hospital mortality was higher with non-HUS TMA (10.2%) than with HUS-TMA (8.5%, p=0.011).

Conclusion

In this large study of TMAs, HUS-TMAs were associated with more renal complications and non-HUS TMAs with more cardiovascular complications. The microvascular derangements in non-HUS TMA might be responsible for the higher incidence of AMI and stroke/TIA, whereas fluid balance disturbances from renal failure might contribute to increased heart failure with HUS-TMA. The high complication rates and mortality associated with these conditions necessitate further research into identifying underlying mechanisms and developing appropriate therapeutic strategies.