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Kidney Week

Abstract: TH-PO275

Risk Factors for Inpatient Mortality in Patients with CKD Hospitalized with Infections due to Multidrug-Resistant Organisms: A Nationally Representative Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Morita, Sae, SBH Health System, Bronx, New York, United States
  • Agrawal, Akshay, SBH Health System, Bronx, New York, United States
  • Nori, Priya, Montefiore Health System, Bronx, New York, United States
  • Apata, Ibironke W., Emory University School of Medicine, Atlanta, Georgia, United States
  • Melamed, Michal L., Montefiore Health System, Bronx, New York, United States
  • Johns, Tanya S., Montefiore Health System, Bronx, New York, United States
Background

The CKD population, especially those with end-stage kidney disease (ESKD) on hemodialysis (HD), has higher rates of infections and more exposure to multidrug-resistant organisms (MDRO). However, few studies have evaluated the risk factors for mortality among CKD patients hospitalized with MDRO infections.

Methods

We extracted data from the 2020 national inpatient sample, the largest nationwide inpatient database in the US, for adults (age ≥18 years) with diagnosis of CKD (non-dialysis dependent CKD) and ESKD (on HD) with MDRO infections (methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, multidrug-resistant gram-negative bacilli and Clostridioides difficile) by ICD 10 codes. The primary outcome was inpatient mortality. We compared the baseline characteristics and constructed multivariable logistic regression models adjusted for socio-demographics, comorbidities, and hospital characteristics to determine the risk factors for inpatient mortality.

Results

There were 49,624 and 15,075 admissions with MDRO infections among patients with CKD and ESKD, respectively. The mean age was 72.5 vs. 63.3 years, females 49.1% vs 47.2%, and White patient accounted for 73.0% vs. 48.9% in CKD vs ESKD group, respectively. Inpatient mortality was higher in ESKD patients compared to CKD patients (9.5% vs.12.1%). Older age and worse comorbidity scores were associated with increased risk of death in both groups. Black patients had higher risk of inpatient mortality compared to White patients (OR 1.40; 95% CI 1.14-1.71) in the CKD but not ESKD group. In the CKD group, hospital characteristics including large bed size, Northeast location, and government ownership were associated with higher risk of death; while in ESRD group, private-investor hospitals had higher mortality.

Conclusion

Inpatient mortality is higher in ESKD compared to CKD patients hospitalized with MDROs. Risk factors for mortality were older age, more comorbidities, and among those with CKD, Black race. Hospital-level risk factors include size, region, and ownership. Further studies should investigate structural, social, and dialysis-related factors on risk of inpatient mortality in CKD and ESKD patients hospitalized with MDRO infections.