Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock

Saraschandra Vallabhajosyula, Shannon M. Dunlay, Gregory W. Barsness, Saarwaani Vallabhajosyula, Shashaank Vallabhajosyula, Pranathi R. Sundaragiri, Bernard J. Gersh, Allan S. Jaffe, Kianoush Kashani

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Abstract

Background There are limited data on acute kidney injury (AKI) complicating acute myocardial infarction with cardiogenic shock (AMI-CS). This study sought to evaluate 15-year national prevalence, temporal trends and outcomes of AKI with no need for hemodialysis (AKI-ND) and requiring hemodialysis (AKI-D) following AMI-CS. Methods This was a retrospective cohort study from 2000–2014 from the National Inpatient Sample (20% stratified sample of all community hospitals in the United States). Adult patients (>18 years) admitted with a primary diagnosis of AMI and secondary diagnosis of CS were included. The primary outcome was in-hospital mortality in cohorts with no AKI, AKI-ND, and AKI-D. Secondary outcomes included predictors, resource utilization and disposition. Results During this 15-year period, 440,257 admissions for AMI-CS were included, with AKI in 155,610 (35.3%) and hemodialysis use in 14,950 (3.4%). Older age, black race, non-private insurance, higher comorbidity, organ failure, and use of cardiac and non-cardiac organ support were associated with the AKI development and hemodialysis use. There was a 2.6-fold higher adjusted risk of developing AKI in 2014 compared to 2000. Presence of AKI-ND and AKI-D was associated with a 1.3 and 1.7-fold higher adjusted risk of mortality. Compared to the cohort without AKI, AKI-ND and AKI-D were associated with longer length of stay (9±10, 12±13, and 18±19 days respectively; p<0.001) and higher hospitalization costs ($101,859 ±116,204, $159,804±190,766, and $265,875 ± 254,919 respectively; p<0.001). Conclusion AKI-ND and AKI-D are associated with higher in-hospital mortality and resource utilization in AMI-CS.

Original languageEnglish (US)
Article numbere0222894
JournalPloS one
Volume14
Issue number9
DOIs
StatePublished - Jan 1 2019

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Vallabhajosyula, S., Dunlay, S. M., Barsness, G. W., Vallabhajosyula, S., Vallabhajosyula, S., Sundaragiri, P. R., Gersh, B. J., Jaffe, A. S., & Kashani, K. (2019). Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock. PloS one, 14(9), [e0222894]. https://doi.org/10.1371/journal.pone.0222894