Trends In Acute Kidney Injury And Associated Outcomes In Patients With Acute Myocardial Infarction In The United States From 2007 Through 2016
Monday, May 20, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Abhishek Chaturvedi
,
Allegheny General Hospital, Pittsburgh, PA
Parul Chandrika, MD
,
East Carolina University, Greenville, NC
Muhammad Salman Faisal, MD
,
Allegheny General Hospital, Pittsburgh, PA
Thomas Robertson, MD
,
Allegheny General Hospital, Pittsburgh, PA
Tarun Sharma, MD
,
Allegheny General Hospital, Pittsburgh, PA
Mario Castagnaro, PhD
,
Allegheny General Hospital, Pittsburgh, PA
George Gabriel, DO FACC
,
WPAHS, Pittsburgh
Background:
Acute kidney injury (AKI) is common in patients with acute myocardial infarction (AMI) and is associated with worse outcomes. We sought to determine temporal trends of AKI only, AKI requiring dialysis (AKID) and associated outcomes in patients with AMI.
Methods
:
We used 2007-2016 National Inpatient Sample to identify 6.1million weighted hospitalizations with AMI and divided them into noAKI, AKI and AKID. Patients with ESRD or AV fistula were excluded. Temporal trends in incidence of AKI/AKID, inpatient mortality (IM), length of stay (LOS) and total hospital charges (CHG) were analyzed.
Results:
Table 1 describes the baseline characteristics and compare noAKI vs AKI vs AKID. From 2007-2016, the incidence of AKI in AMI increased from 9.6% to 18.2% (p <0.001) whereas AKID increased from 0.5% to 0.6% (p=0.005). IM in AKID remained highest and increased from 32.5% to 35.8% (p=0.001) but decreased in both noAKI and AKI groups (p<0.001). All groups showed a declining trend in LOS but increasing CHG over the study period. Finally, AKID was associated with highest odds of IM [OR (CI): 8 (7.5-8.6), p <0.001], prolonged LOS (β, p: 0.08, p <0.001) and increased CHG (β, p: 0.14, p <0.001) followed by AKI, and the association remained significant beyond adjustment for age, gender, race, comorbidities, insurance and financial status (Table 1).
Conclusions:
The incidence of AKI and AKID continues to rise and is associated with increased IM, LOS and CHG in AMI patients. Increasing IM in AKID was most likely due to overall sicker population and decreasing IM in AKI and noAKI groups perhaps reflect physician awareness and early implementation of renal protective strategies. 
