National Trends and Impact of Acute Kidney Injury Requiring Hemodialysis in Hospitalizations With Atrial Fibrillation

Chan, Lili; Mehta, Swati; Chauhan, Kinsuk; Poojary, Priti; Patel, Sagar; Pawar, Sumeet; Patel, Achint; Correa, Ashish; Patel, Shanti; Garimella, Pranav S.; Annapureddy, Narender; Agarwal, Shiv Kumar; Gidwani, Umesh; Coca, Steven G.; Nadkarni, Girish N.

doi:10.1161/jaha.116.004509

Cited by 19 publications

(16 citation statements)

References 38 publications

(77 reference statements)

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“…In the current study, incident AF was associated with several major adverse events ( Table 4 ). Similar findings were also demonstrated that the development of AKI-D was associated with increased risk of in-hospital mortality and adverse events among patients with AF [ 2 ]. Following our results, patients who have AF and AKI will have a high incidence of cardiovascular events, especially coronary events and ischemic stroke.…”

Section: Discussionsupporting

confidence: 77%

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Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

Shiao

Wang

Lin

et al. 2018

JCM

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The influence of acute kidney injury (AKI) on subsequent incident atrial fibrillation (AF) has not yet been fully addressed. This retrospective nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2010. A total of 41,463 patients without a previous AF, mitral valve disease, and hyperthyroidism who developed de novo dialysis-requiring AKI (AKI-D) during their index hospitalization were enrolled. After propensity score matching, “non-recovery group” (n = 2895), “AKI-recovery group” (n = 2895) and “non-AKI group” (control group, n = 5790) were categorized. Within a follow-up period of 6.52 ± 3.88 years (median, 6.87 years), we found that the adjusted risks for subsequent incident AF were increased in both AKI-recovery group (adjusted hazard ratio (aHR) = 1.30; 95% confidence intervals (CI), 1.07–1.58; p ≤ 0.01) and non-recovery group (aHR = 1.62; 95% CI, 1.36–1.94) compared to the non-AKI group. Furthermore, the development of AF carried elevated risks for major adverse cardiac events (aHR = 2.11; 95% CI, 1.83–2.43), ischemic stroke (aHR = 1.33; 95% CI, 1.19–1.49), and all stroke (aHR = 1.28; 95% CI, 1.15–1.43). (all p ≤ 0.001, except otherwise expressed) The authors concluded that AKI-D, even in those who withdrew from temporary dialysis, independently increases the subsequent risk of de novo AF.

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Section: Discussionsupporting

confidence: 77%

“…AF has a significant effect on cardiovascular events including stroke, peripheral embolization, and associated morbidities and mortalities [ 1 ]. The existence of AF is independently associated with the risk of the development and severity of acute kidney injury (AKI) in both surgical and medical settings [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

Shiao

Wang

Lin

et al. 2018

JCM

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“…The results of our study are consistent with data from other non-AMI populations, which have demonstrated a steady increase in AKI prevalence. [17, 27, 28] In unselected AMI patients, Amin et al noted a decrease in the incidence and in-hospital mortality from AKI in all AMI patients. [13] They postulated that this may be partly due to greater recognition and the effective use of preventive strategies.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock

et al. 2019

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BackgroundThere are limited data on acute kidney injury (AKI) complicating acute myocardial infarction with cardiogenic shock (AMI-CS). This study sought to evaluate 15-year national prevalence, temporal trends and outcomes of AKI with no need for hemodialysis (AKI-ND) and requiring hemodialysis (AKI-D) following AMI-CS.MethodsThis was a retrospective cohort study from 2000–2014 from the National Inpatient Sample (20% stratified sample of all community hospitals in the United States). Adult patients (>18 years) admitted with a primary diagnosis of AMI and secondary diagnosis of CS were included. The primary outcome was in-hospital mortality in cohorts with no AKI, AKI-ND, and AKI-D. Secondary outcomes included predictors, resource utilization and disposition.ResultsDuring this 15-year period, 440,257 admissions for AMI-CS were included, with AKI in 155,610 (35.3%) and hemodialysis use in 14,950 (3.4%). Older age, black race, non-private insurance, higher comorbidity, organ failure, and use of cardiac and non-cardiac organ support were associated with the AKI development and hemodialysis use. There was a 2.6-fold higher adjusted risk of developing AKI in 2014 compared to 2000. Presence of AKI-ND and AKI-D was associated with a 1.3 and 1.7-fold higher adjusted risk of mortality. Compared to the cohort without AKI, AKI-ND and AKI-D were associated with longer length of stay (9±10, 12±13, and 18±19 days respectively; p<0.001) and higher hospitalization costs ($101,859±116,204, $159,804±190,766, and $265,875 ± 254,919 respectively; p<0.001).ConclusionAKI-ND and AKI-D are associated with higher in-hospital mortality and resource utilization in AMI-CS.

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“…A retrospective cohort study by Nelson et al observed 55 962 patients with CKD, and the results showed that survival after incident AF decreased progressively as CKD stage increased, and the one-year mortality rate for patients with CKD stages 3 to 5 with AF was 35.6% [ 19 ]. However, there have been few studies on the association between in-hospital AKI and adverse hospital prognosis in patients with AF [ 7 , 20 ]. Veleiro reported that 804 patients with AF aged >75 years were hospitalized for any cause, of whom 119 (14.8%) developed in-hospital AKI, and AKI was associated with the in-hospital mortality of patients (OR 2.4, 95% CI 1.03–5.53) [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

In-hospital acute kidney injury and atrial fibrillation: incidence, risk factors, and outcome

Wang

Yang

et al. 2021

Renal Failure

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Background: The incidence and the risk factors of in-hospitalized acute kidney injury (AKI) in patients hospitalized for atrial fibrillation (AF) were unclear. Methods: The Improving Care for Cardiovascular Disease in China-AF (CCC-AF) project is an ongoing registry and quality improvement project, with 240 hospitals recruited across China. We selected 4527 patients hospitalized for AF registered in the CCC-AF from January 2015 to January 2019. Patients were divided into the AKI and non-AKI groups according to the changes in serum creatinine levels during hospitalization. Results: Among the 4527 patients, the incidence of AKI was 8.0% (361/4527). Multivariate logistic analysis results indicated that the incidence of in-hospital AKI in patients with AF on admission was 2.6 times higher than that in patients with sinus rhythm (OR 2.60, 95% CI 1.77-3.81). Age (per 10-year increase, OR 1.22, 95% CI 1.07-1.38), atrial flutter/atrial tachycardia on admission (OR 2.16, 95% CI 1.12-4.15), diuretics therapy before admission (OR 1.48, 95% CI 1.07-2.04) and baseline hemoglobin (per 20 g/L decrease, OR 1.21, 95% CI 1.10-1.32) were independent risk factors for in-hospital AKI. b blockers therapy given before admission (OR 0.67, 95% CI 0.51-0.87) and non-warfarin therapy during hospitalization (OR 0.71, 95% CI 0.53-0.96) were associated with a decreased risk of in-hospital AKI. After adjustment for confounders, in-hospital AKI was associated with a 34% increase in risk of major adverse cardiovascular (OR 1.34, 95% CI 1.02-1.90, p ¼ 0.023). Conclusions: Clinicians should pay attention to the monitoring and prevention of in-hospital AKI to improve the prognosis of patients with AF.

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National Trends and Impact of Acute Kidney Injury Requiring Hemodialysis in Hospitalizations With Atrial Fibrillation

Cited by 19 publications

References 38 publications

Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock

In-hospital acute kidney injury and atrial fibrillation: incidence, risk factors, and outcome

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