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Kidney Week

Abstract: PO0173

Readmissions After AKI in Colorectal Carcinoma Are Associated with Adverse Outcomes: Findings from the National Readmission Database

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Prado, Victor E., University of Cincinnati, Cincinnati, Ohio, United States
  • Salazar, Miguel, Cleveland Clinic, Cleveland, Ohio, United States
Background

Acute kidney injury (AKI) is common in critically ill cancer patients with poor outcomes. Colorectal carcinomas (CRC) are frequently associated with AKI, due to complications of disease or treatment. AKI in CRC remains a well-known but under-represented topic in current literature. We aim to analyze and quantify the impact, healthcare burden, readmission rates and predictors of metastatic CRC with AKI.

Methods

We conducted a retrospective cohort study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for AKI with a concomitant diagnosis of CRC. ICD 10 codes were used to identify diagnoses and procedures.

Results

A total of 2,239 patients with metastatic colorectal cancer were admitted with AKI. The 30-day readmission rate was 27.9%. Main causes for readmission were sepsis, progression of malignancy, hypovolemia and recurrent AKI. Readmitted patients were associated with higher in-hospital mortality (0.1% vs. 1.5%; p<0.01), mechanical ventilation need (4.7% vs 1.5%; P<0.01) and chronic kidney disease (CKD) diagnosis (44.6% vs 36.1%; P<0.01). The total health care in-hospital economic burden of readmission was $32.3 million in total charges and $7.8 million in total costs. After adjusting for age and comorbidities, independent predictors of readmission were disposition against medical advice, HIV, CKD, and sepsis. Preventive factors for readmission were found to be radiation therapy and peripheral parenteral nutrition.

Conclusion

AKI in metastatic CRC has a high rate of readmissions, with poor outcomes in morbidity, mortality and costs making it a significant healthcare burden. Among common causes of readmission, potentially targetable causes include hypovolemia and sepsis while among readmission predictors, CKD and sepsis warrant further attention. Abovementioned preventive predictors consolidate the importance of combination therapy and supportive care in CRC.

Predictors of Readmissions
VariableAdjusted odds ratio (95% confidence interval)P value
Comorbidities
HIV2.95 (1.58-5.49)<0.01
CKD1.46 (1.10-1.93)<0.01
Radiation therapy0.59 (0.14-0.39)<0.01
In-Hospital Complications
Sepsis2.19 (1.01-4.84)0.05
In-Hospital Procedures
Peripheral parenteral nutrition0.33 (0.07-0.56)<0.01