Abstract: SA-PO1226
National Incidence, Predictors, and Outcomes of AKI After Cardiac Implantable Electronic Device Placement in Patients with Active Malignancy
Session Information
- Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Capriles, Guido M., TriHealth Inc, Cincinnati, Ohio, United States
- Abdeltawwab, Mohannad, TriHealth Inc, Cincinnati, Ohio, United States
- Singh, Gurjot, TriHealth Inc, Cincinnati, Ohio, United States
- Vanaparti, Ankitha, TriHealth Inc, Cincinnati, Ohio, United States
- Rajput, Amit K., TriHealth Inc, Cincinnati, Ohio, United States
- Zamani, Taraneh, TriHealth Inc, Cincinnati, Ohio, United States
Background
Acute kidney injury (AKI) is a severe complication following cardiac implantable electronic device (CIED) placement. Patients with active malignancy are a highly vulnerable population owing to systemic inflammation, hemodynamic fluctuations, and nephrotoxic exposures. The intersection of cardio-oncology and nephrology remains understudied regarding CIED-associated AKI risk and its prognostic implications.
Methods
We conducted a retrospective cohort study utilizing the National Inpatient Sample (2017-2020), capturing adult hospitalizations for permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) insertion. Active malignancy was identified via ICD-10-CM codes (C00-C96). Using 1:1 propensity score matching (PSM) adjusting for demographics and baseline comorbidities, we matched cancer patients to non-cancer controls. Within the active malignancy cohort, multivariable weighted logistic regression identified independent predictors of post-procedural AKI, and outcomes were evaluated using design-based statistical testing.
Results
From 151,003 CIED procedures, we identified 10,872 patients with active malignancy. The national incidence of post-CIED AKI in this cohort was 27.1%. Following PSM (10,872 matched pairs), AKI incidence remained significantly higher in the cancer cohort compared to non-cancer controls (27.1% vs. 25.3%; p=0.0027). Among patients with active malignancy, independent predictors of post-procedural AKI included pre-existing CKD (OR 3.48; 95% CI 3.13–3.87), heart failure (OR 1.67; 95% CI 1.49–1.86), and ICD implantation versus PPM (OR 1.18; 95% CI 1.05-1.33). Age and race were not significant. Developing post-procedural AKI in cancer patients was associated with devastating in-hospital outcomes, including a five-fold higher mortality (4.37% vs. 0.86%; p<0.001), prolonged hospitalization (+5.5 days; p<0.001), and amplified healthcare expenditures (+$21,307; p<0.001).
Conclusion
Active malignancy is an independent risk factor for post-procedural AKI following CIED placement, conferring significantly elevated inpatient mortality and resource utilization. The robust predictive value of baseline CKD, heart failure, and ICD selection emphasizes the critical necessity for vigilant pre-procedural nephrology evaluation and targeted renal-protective strategies in the complex cardio-oncology population.