National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States Journal Article


Authors: Nadkarni, G. N.; Simoes, P. K.; Patel, A.; Patel, S.; Yacoub, R.; Konstantinidis, I.; Kamat, S.; Annapureddy, N.; Parikh, C. R.; Coca, S. G.
Article Title: National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States
Abstract: 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. 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. 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. 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.
Keywords: mortality; cirrhosis; infection; complications; metaanalysis; acute kidney injury; acute-renal-failure; dialysis; hepatitis-c; clinical-course; chronic liver-disease; inpatient sample analysis; aki
Journal Title: Hepatology International
Volume: 10
Issue: 3
ISSN: 1936-0533
Publisher: Springer  
Date Published: 2016-05-01
Start Page: 525
End Page: 531
Language: English
ACCESSION: WOS:000373595200018
DOI: 10.1007/s12072-016-9706-9
PROVIDER: wos
PUBMED: 26825548
Notes: Article -- Source: Wos
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  1. Priya Karen Simoes
    11 Simoes