TY - JOUR
T1 - Acute Kidney Injury With Ventricular Assist Device Placement
T2 - National Estimates of Trends and Outcomes
AU - Walther, Carl P.
AU - Winkelmayer, Wolfgang C.
AU - Niu, Jingbo
AU - Cheema, Faisal H.
AU - Nair, Ajith P.
AU - Morgan, Jeffrey A.
AU - Fedson, Savitri E.
AU - Deswal, Anita
AU - Navaneethan, Sankar D.
N1 - Funding Information:
Carl P. Walther, MD, MS, Wolfgang C. Winkelmayer, MD, ScD, MPH, Jingbo Niu, MD, DSc, Faisal H. Cheema, MD, Ajith P. Nair, MD, Jeffrey A. Morgan, MD, Savitri E. Fedson, MD, MA, Anita Deswal, MD, MPH, and Sankar D. Navaneethan, MD, MS, MPH. Research idea and study design: CPW, WCW, SDN; data acquisition: CPW; data analysis/interpretation: CPW, WCW, JN, FHC, APN, JAM, SEF, AD, SDN; statistical analysis: CPW; supervision or mentorship: SDN, WCW. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. There was no funding for this study. Unrelated to the work described in this article, Dr Navaneethan has served on the event adjudication committee for clinical trials sponsored by Bayer and Boehringer Ingelheim, served as a consultant for Tricida, and received investigator-initiated research support from Keryx Pharmaceuticals. The other authors declare that they have no relevant financial interests. Received October 8, 2018. Evaluated by 3 external peer reviewers and a statistician, with editorial input from an Acting Editor-in-Chief (Editorial Board Member Kathleen Liu, MD, PhD). Accepted in revised form March 18, 2019. The involvement of an Acting Editor-in-Chief to handle the peer-review and decision-making processes was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Publisher Copyright:
© 2019 National Kidney Foundation, Inc.
PY - 2019/11
Y1 - 2019/11
N2 - Rationale & Objective: Ventricular assist devices (VADs) are used for end-stage heart failure not amenable to medical therapy. Acute kidney injury (AKI) in this setting is common due to heart failure decompensation, surgical stress, and other factors. Little is known about national trends in AKI diagnosis and AKI requiring dialysis (AKI-D) and associated outcomes with VAD implantation. We investigated national estimates and trends for diagnosed AKI, AKI-D, and associated patient and resource utilization outcomes in hospitalizations in which implantable VADs were placed. Study Design: Cohort study of 20% stratified sample of US hospitalizations. Setting & Participants: Patients who underwent implantable VAD placement in 2006 to 2015. Exposure: No AKI diagnosis, AKI without dialysis, AKI-D. Outcomes: In-hospital mortality, length of stay, estimated hospitalization costs. Analytical Approach: Multivariate logistic and linear regression using survey design methods to account for stratification, clustering, and weighting. Results: An estimated 24,140 implantable VADs were placed, increasing from 853 in 2006 to 3,945 in 2015. AKI was diagnosed in 56.1% of hospitalizations and AKI-D occurred in 6.5%. AKI diagnosis increased from 44.0% in 2006 to 2007 to 61.7% in 2014 to 2015; AKI-D declined from 9.3% in 2006 to 2007 to 5.2% in 2014 to 2015. Mortality declined in all AKI categories but this varied by category: those with AKI-D had the smallest decline. Adjusted hospitalization costs were 19.1% higher in those with diagnosed AKI and 39.6% higher in those with AKI-D, compared to no AKI. Limitations: Administrative data; timing of AKI with respect to VAD implantation cannot be determined; limited pre-existing chronic kidney disease ascertainment; discharge weights not derived for subpopulation of interest. Conclusions: A decreasing proportion of patients undergoing VAD implantation experience AKI-D, but mortality among these patients remains high. AKI diagnosis with VAD implantation is increasing, possibly reflecting changes in AKI surveillance, awareness, and coding.
AB - Rationale & Objective: Ventricular assist devices (VADs) are used for end-stage heart failure not amenable to medical therapy. Acute kidney injury (AKI) in this setting is common due to heart failure decompensation, surgical stress, and other factors. Little is known about national trends in AKI diagnosis and AKI requiring dialysis (AKI-D) and associated outcomes with VAD implantation. We investigated national estimates and trends for diagnosed AKI, AKI-D, and associated patient and resource utilization outcomes in hospitalizations in which implantable VADs were placed. Study Design: Cohort study of 20% stratified sample of US hospitalizations. Setting & Participants: Patients who underwent implantable VAD placement in 2006 to 2015. Exposure: No AKI diagnosis, AKI without dialysis, AKI-D. Outcomes: In-hospital mortality, length of stay, estimated hospitalization costs. Analytical Approach: Multivariate logistic and linear regression using survey design methods to account for stratification, clustering, and weighting. Results: An estimated 24,140 implantable VADs were placed, increasing from 853 in 2006 to 3,945 in 2015. AKI was diagnosed in 56.1% of hospitalizations and AKI-D occurred in 6.5%. AKI diagnosis increased from 44.0% in 2006 to 2007 to 61.7% in 2014 to 2015; AKI-D declined from 9.3% in 2006 to 2007 to 5.2% in 2014 to 2015. Mortality declined in all AKI categories but this varied by category: those with AKI-D had the smallest decline. Adjusted hospitalization costs were 19.1% higher in those with diagnosed AKI and 39.6% higher in those with AKI-D, compared to no AKI. Limitations: Administrative data; timing of AKI with respect to VAD implantation cannot be determined; limited pre-existing chronic kidney disease ascertainment; discharge weights not derived for subpopulation of interest. Conclusions: A decreasing proportion of patients undergoing VAD implantation experience AKI-D, but mortality among these patients remains high. AKI diagnosis with VAD implantation is increasing, possibly reflecting changes in AKI surveillance, awareness, and coding.
KW - AKI incidence
KW - Acute kidney injury (AKI)
KW - dialysis
KW - heart failure
KW - hospital length-of-stay
KW - hospitalization cost
KW - in-hospital mortality
KW - ventricular assist device (VAD)
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U2 - 10.1053/j.ajkd.2019.03.423
DO - 10.1053/j.ajkd.2019.03.423
M3 - Article
C2 - 31160142
AN - SCOPUS:85066338604
SN - 0272-6386
VL - 74
SP - 650
EP - 658
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -