Prevalence of acute kidney injury in myeloma patients visiting U.S. emergency departments: A nationwide analysis.

Abstract

e20548 Background: Patients diagnosed with multiple myeloma (MM) frequently visit emergency departments (ED) with complications, commonly with kidney disease. However, data regarding the prevalence of acute kidney injury (AKI) and its effects on patient outcome, economic burden, length of hospital stay and mortality among these patients are lacking. Methods: From the Nationwide Emergency Department Sample, we obtained 7-year (2010-2016) data of myeloma patients who visited ED. Baseline characteristics of these patients with and without AKI were compared. The multivariable regression model was used to estimate hospital admission, length of stay, healthcare burden and in-hospital mortality in patients with and without AKI. Results: Between 2010-2016, 657,392 adult myeloma patients visited ED at an increased rate from 35 to 45 per 100,000 census population. The prevalence of AKI was 22.5% (n = 147,743) with a stable trend over the study period. AKI was more common in patients with relapsed MM (33.5%) than those in remission (18.6%) or never achieving remission (22.4%) (P < 0.001), male (24.1 vs 20.6% in female, P < 0.001), age ≥65 years (24.1%) vs 18-44 years (12.9%), or 45-64 years (19.3%)(P < 0.001) and urban (23.3%) vs non-urban residents (17.9%)(P < 0.001). The majority patients with AKI were hospitalized (96.5%) compared with those without AKI (69.6%) (P < 0.001). In multivariable analysis, odds of hospitalization was higher in patients with AKI (OR: 8.8, P < 0.001) after adjusting age, gender, co-morbidities and other demographics. Median hospital stay was longer in patients with AKI compared to those without (6 vs 4 days, P < 0.001). Median ED and total hospitalization charges were higher in patients with AKI (ED: $2,057; total: $45,414) vs without AKI (ED: $1,853; total: $29,299) (P < 0.001). In the multivariable adjusted-model, odds of in-hospital mortality was significantly higher in patients not in remission (OR: 1.8), patients with relapse (OR: 2.3), AKI (OR: 2.2), age ≥ 65 years (OR: 1.4), male (OR: 1.1) and urban residents (OR:1.2). Conclusions: In this largest national study of MM patients visiting ED, patients with AKI had higher in-hospital admission, ED and total charges, length of hospital stays, and mortality, both by univariate and multivariate analysis. Prevalence of AKI and mortality were highest in patients with MM relapse.