- Email: [email protected]
TRENDS AND OUTCOMES IN DIALYSIS REQUIRING ACUTE KIDNEY INJURY AFTER AORTIC VALVE REPLACEMENT INSIGHT FROM THE NATIONWIDE INPATIENT SAMPLE
1994 JACC March 21, 2017 Volume 69, Issue 11
Valvular Heart Disease TRENDS AND OUTCOMES IN DIALYSIS REQUIRING ACUTE KIDNEY INJURY AFTER AORTIC VALVE REPLACEMENT INSIGHT FROM THE NATIONWIDE INPATIENT SAMPLE Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Outcomes in Valvular Heart Disease Abstract Category: 36. Valvular Heart Disease: Clinical Presentation Number: 1273-028 Authors: Sami Aljohani, Fahad Alqahtani, Ahmed Almustafa, Khaled Boobes, Mohammad Akram Kawsara, Chalak Berzingi, Mohamad Alkhouli, West Virgnian Univesity Heart and Vascular Institute, Morgantown, WV, USA Background: Acute kidney injury (AKI) is a common complication following aortic valve replacement (AVR). We sought to describe the temporal trends of AKI requiring dialysis (AKI-D) and its impact on in-hospital mortality in patients undergoing AVR in a nationwide representative sample.
Methods: We used the Nationwide Inpatient Sample to identify 138,092 patients who underwent AVR between 2004-2013, of whom 2498 (1.8%) developed AKI-D postoperatively. Multivariable logistic regression derived propensity scores were matched 1:1 to attain 2431 pairs of patients who experienced AKI-D versus those who did not to assess in-hospital outcomes.
Results: The incidence of AKI-D increased from 2004 to 2013 (p=0.017), with a non-significant decrease of in-hospital mortality (p=0.323). In a propensity matched comparison, AKI-D group was associated with increased mortality compared to non-AKI group (34.3% vs 9% p= <0.001). Heart failure (OR=1.9, p=<0.001), coagulopathy (OR=1.4, p=<0.001), preoperative renal dysfunction (OR=1.25, p=0.023) and concurrent coronary bypass grafting (OR=1.25, p=0.027) were independent predictors of mortality in patients with AKI-D. Conclusions: Our study reveals worsening trends of AKI-D after AVR in the United States. The development of AKI-D confers a 4-folds increase in in-hospital mortality, and this excess mortality remained constant during the study period. These results signify the need for avenues to prevent, recognize and treat AKI in patients undergoing AVR.
Valvular Heart Disease TRENDS AND OUTCOMES IN DIALYSIS REQUIRING ACUTE KIDNEY INJURY AFTER AORTIC VALVE REPLACEMENT INSIGHT FROM THE NATIONWIDE INPATIENT SAMPLE Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Outcomes in Valvular Heart Disease Abstract Category: 36. Valvular Heart Disease: Clinical Presentation Number: 1273-028 Authors: Sami Aljohani, Fahad Alqahtani, Ahmed Almustafa, Khaled Boobes, Mohammad Akram Kawsara, Chalak Berzingi, Mohamad Alkhouli, West Virgnian Univesity Heart and Vascular Institute, Morgantown, WV, USA Background: Acute kidney injury (AKI) is a common complication following aortic valve replacement (AVR). We sought to describe the temporal trends of AKI requiring dialysis (AKI-D) and its impact on in-hospital mortality in patients undergoing AVR in a nationwide representative sample.
Methods: We used the Nationwide Inpatient Sample to identify 138,092 patients who underwent AVR between 2004-2013, of whom 2498 (1.8%) developed AKI-D postoperatively. Multivariable logistic regression derived propensity scores were matched 1:1 to attain 2431 pairs of patients who experienced AKI-D versus those who did not to assess in-hospital outcomes.
Results: The incidence of AKI-D increased from 2004 to 2013 (p=0.017), with a non-significant decrease of in-hospital mortality (p=0.323). In a propensity matched comparison, AKI-D group was associated with increased mortality compared to non-AKI group (34.3% vs 9% p= <0.001). Heart failure (OR=1.9, p=<0.001), coagulopathy (OR=1.4, p=<0.001), preoperative renal dysfunction (OR=1.25, p=0.023) and concurrent coronary bypass grafting (OR=1.25, p=0.027) were independent predictors of mortality in patients with AKI-D. Conclusions: Our study reveals worsening trends of AKI-D after AVR in the United States. The development of AKI-D confers a 4-folds increase in in-hospital mortality, and this excess mortality remained constant during the study period. These results signify the need for avenues to prevent, recognize and treat AKI in patients undergoing AVR.