Abstract: SA-PO310
Interdialytic Creatinine Rise as a Predictor of Hospital Length of Stay and Cause of Shortness of Breath in ESRD Patients
Session Information
- Fluid and Electrolytes: Basic - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid and Electrolytes
- 901 Fluid and Electrolytes: Basic
Authors
- Patel, Hamel, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
- Smotherman, Carmen, UF Health Jacksonville, Jacksonville, Florida, United States
- Ilic, Ljubomir M., UF Health Jacksonville, Jacksonville, Florida, United States
Background
The Interdialytic Creatinine Rise (IDCR), calculated as the change in serum creatinine over time, in mg/dL/h, has been proposed as a novel marker of volume status and mortality in patients with end-stage-renal-disease (ESRD). We wanted to determine if IDCR was associated with the hospital length of stay (LOS), a metric reflecting the opposing factors of hospital efficiency and patient risks. We also studied a subgroup of patients in order to evaluate the relationship of IDCR to the cause of their shortness of breath (SOB).
Methods
This was a prospective cohort study of 142 ESRD patients on hemodialysis admitted to our institution who were followed from admission until discharge. IDCR was calculated as the difference in two serum creatinine values divided by the time between the samples. LOS and potential confounders of age, gender, race, cirrhosis, active cancer, left ventricular ejection fraction (LVEF) <40%, and insurance status were recorded. A sub-cohort of 53 patients admitted due to SOB as documented in emergency room records was divided into two groups according to the cause of SOB documented in the discharge summary, as SOB due to volume excess or not. The data was analyzed using univariate analyses, multiple regression, and multiple logistic regression.
Results
IDCR is negatively associated with LOS (Spearman correlation= –0.245; p=0.003). Adjusting for the significant covariates of age, gender, race, LVEF<40 and insurance, IDCR is negatively associated with LOS; so that for every 0.021 mg/dL/h increase in IDCR, LOS decreases by 1 day (95%CI -1.6,-0.4; p=0.002). In the subset of patients with SOB, 11 patients had SOB unrelated to volume excess and 42 patients had SOB due to volume excess, with significantly different respective IDCRs of 0.09 and 0.06 (Wilcoxon's Rank Sum Test; p=0.018). Adjusting for the significant covariate of age, when IDCR increases by 0.03 the odds ratio of SOB being unrelated to volume excess is 2.45 (95% CI 1.23, 5.80; p=0.02).
Conclusion
Our study showed that ESRD patients with lower IDCR values due to volume overload or decreased creatinine production have increased LOS, likely due to their higher risk. In ESRD patients admitted with SOB, higher IDCR values are more likely to exclude hypervolemia as the cause of SOB.