TY - JOUR
T1 - National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States
AU - Nadkarni, Girish N.
AU - Simoes, Priya K.
AU - Patel, Achint
AU - Patel, Shanti
AU - Yacoub, Rabi
AU - Konstantinidis, Ioannis
AU - Kamat, Sunil
AU - Annapureddy, Narender
AU - Parikh, Chirag R.
AU - Coca, Steven G.
N1 - Publisher Copyright:
© 2016, Asian Pacific Association for the Study of the Liver.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background and aims: Cirrhosis affects 5.5 million patients with estimated costs of US$4 billion. Previous studies about dialysis requiring acute kidney injury (AKI-D) in decompensated cirrhosis (DC) are from a single center/year. We aimed to describe national trends of incidence and impact of AKI-D in DC hospitalizations. Methods: We extracted our cohort from the Nationwide Inpatient Sample (NIS) from 2006–2012. We identified hospitalizations with DC and AKI-D by validated ICD9 codes. We analyzed temporal changes in DC hospitalizations complicated by AKI-D and utilized multivariable logistic regression models to estimate AKI-D impact on hospital mortality. Results: We identified a total of 3,655,700 adult DC hospitalizations from 2006 to 2012 of which 78,015 (2.1 %) had AKI-D. The proportion with AKI-D increased from 1.5 % in 2006 to 2.23 % in 2012; it was stable between 2009 and 2012 despite an increase in absolute numbers from 6773 to 13,930. The overall hospital mortality was significantly higher in hospitalizations with AKI-D versus those without (40.87 vs. 6.96 %; p < 0.001). In an adjusted multivariable analysis, adjusted odds ratio for mortality was 2.17 (95 % CI 2.06–2.28; p < 0.01) with AKI-D, which was stable from 2006 to 2012. Changes in demographics and increases in acute/chronic comorbidities and procedures explained temporal changes in AKI-D. Conclusions: Proportion of DC hospitalizations with AKI-D increased from 2006 to 2009, and although this was stable from 2009 to 2012, there was an increase in absolute cases. These results elucidate the burden of AKI-D on DC hospitalizations and excess associated mortality, as well as highlight the importance of prevention, early diagnosis and testing of novel interventions in this vulnerable population.
AB - Background and aims: Cirrhosis affects 5.5 million patients with estimated costs of US$4 billion. Previous studies about dialysis requiring acute kidney injury (AKI-D) in decompensated cirrhosis (DC) are from a single center/year. We aimed to describe national trends of incidence and impact of AKI-D in DC hospitalizations. Methods: We extracted our cohort from the Nationwide Inpatient Sample (NIS) from 2006–2012. We identified hospitalizations with DC and AKI-D by validated ICD9 codes. We analyzed temporal changes in DC hospitalizations complicated by AKI-D and utilized multivariable logistic regression models to estimate AKI-D impact on hospital mortality. Results: We identified a total of 3,655,700 adult DC hospitalizations from 2006 to 2012 of which 78,015 (2.1 %) had AKI-D. The proportion with AKI-D increased from 1.5 % in 2006 to 2.23 % in 2012; it was stable between 2009 and 2012 despite an increase in absolute numbers from 6773 to 13,930. The overall hospital mortality was significantly higher in hospitalizations with AKI-D versus those without (40.87 vs. 6.96 %; p < 0.001). In an adjusted multivariable analysis, adjusted odds ratio for mortality was 2.17 (95 % CI 2.06–2.28; p < 0.01) with AKI-D, which was stable from 2006 to 2012. Changes in demographics and increases in acute/chronic comorbidities and procedures explained temporal changes in AKI-D. Conclusions: Proportion of DC hospitalizations with AKI-D increased from 2006 to 2009, and although this was stable from 2009 to 2012, there was an increase in absolute cases. These results elucidate the burden of AKI-D on DC hospitalizations and excess associated mortality, as well as highlight the importance of prevention, early diagnosis and testing of novel interventions in this vulnerable population.
KW - Acute kidney injury
KW - Cirrhosis
KW - Dialysis
KW - Mortality
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U2 - 10.1007/s12072-016-9706-9
DO - 10.1007/s12072-016-9706-9
M3 - Article
C2 - 26825548
AN - SCOPUS:84955618200
SN - 1936-0533
VL - 10
SP - 525
EP - 531
JO - Hepatology International
JF - Hepatology International
IS - 3
ER -