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Kidney Week

Abstract: PO0070

AKI in Sickle Cell Disease

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Li, Si, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
  • Elavia, Nasha, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
  • Wang, Yichen, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
  • Milekic, Bojana, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
Background

Sickle cell disease may cause acute injury to the kidney, especially during sickle cell crisis. Which mainly related to underlying stress-induced renal vasculopathy and alterations in glomerular hemodynamics. There is a paucity of national-level evidence showing the effect of acute kidney injury (AKI) on patients hospitalized with sickle cell disease. We aim to quantify the relationship between AKI and mortality and resource utilization in patients with sickle cell disease.

Methods

We analyzed adult patients admitted from 2012 to 2014 with a primary or secondary diagnosis of sickle cell disease using the Nationwide Inpatient Sample (NIS). The NIS is the largest publicly available inpatient database in the United States (U.S.). It contains data from approximately 8 million hospital stays each year, representing a 20% stratified sample of all U.S. non-federal hospitals, and is sponsored by the Agency for Healthcare Research and Quality and the Healthcare Cost and Utilization Project (HCUP). The International Classification of Diseases, Ninth Revision, Clinical Modification Coding System (ICD-9-CM) was used to identify comorbidities. Survey multivariate regression analysis was performed using STATA 16.0.

Results

We included 240,550 admissions with sickle cell disease, majority of them were black patients (93%). 10,825 (4.5%) of sickle cell disease patients had AKI. Patients with AKI were older (mean age 41.3±12.5 vs. 31.1±10.4, p<0.001), more likely to be male (53.1% vs. 44.4%, p<0.001). Sickle cell disease patients had higher prevalence of hypertension (49.9% vs. 16.8%, p<0.001), coronary artery disease (6.3% vs. 2.1%, p<0.001), congestive heart failure (22.5% vs. 4.4%, p<0.001), diabetes mellitus (9.8% vs. 3.5%, p<0.001). After adjusting for patient and hospital-level confounders, patients with AKI had higher odds of mortality (adjusted odds ratio [aOR] 11.3, 95% confidence interval [CI] 7.04- 18.34, p<0.001), a longer length of stay (2.6 days, 95% CI: 2.21- 2.93 days, p<0.001), higher costs ($6707.2; 95% CI: $5816.2-$7598.3, p<0.001).

Conclusion

The demographic characteristics were significantly different between patients with or without AKI. Sickle cell nephropathy imposes a burden on both individual and health care systems. Randomized controlled trials are needed to investigate the role of vaso-occlusive events on AKI development.