scholarly journals Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States

2016 ◽  
Vol 43 (4) ◽  
pp. 261-270 ◽  
Author(s):  
Jeremiah R. Brown ◽  
Michael E. Rezaee ◽  
William M. Hisey ◽  
Kevin C. Cox ◽  
Michael E. Matheny ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Incidence Rate ◽  
Hospital Admissions ◽  
Population Attributable Risk ◽  
Kidney Injury ◽  
The United States ◽  
Attributable Risk ◽  
Discharge Data ◽  
The Us

Background: Dialysis-requiring acute kidney injury (AKI-D) is a documented complication of hospitalization and procedures. Temporal incidence of AKI-D and related hospital mortality in the US population has not been recently characterized. We describe the epidemiology of AKI-D as well as associated in-hospital mortality in the US. Methods: Retrospective cohort of a national discharge data (n = 86,949,550) from the Healthcare Cost and Utilization Project's National Inpatient Sample, 2001-2011 of patients' hospitalization with AKI-D. Primary outcomes were AKI-D and in-hospital mortality. We determined the annual incidence rate of AKI-D in the US from 2001 to 2011. We estimated ORs for AKI-D and in-hospital mortality for each successive year compared to 2001 using multiple logistic regression models, adjusted for patient and hospital characteristics, and stratified the analyses by sex and age. We also calculated population-attributable risk of in-hospital mortality associated with AKI-D. Results: The adjusted odds of AKI-D increased by a factor of 1.03 (95% CI 1.02-1.04) each year. The number of AKI-D-related (19,886-34,195) in-hospital deaths increased almost 2-fold, although in-hospital mortality associated with AKI-D (28.0-19.7%) declined significantly from 2001 to 2011. Over the same period, the adjusted odds of mortality for AKI-D patients were 0.60 (95% CI 0.56-0.67). Population-attributable risk of mortality associated with AKI-D increased (2.1-4.2%) over the study period. Conclusions: The incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly.

Hospitalization for complications due to systemic therapy in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7078-7078
Author(s):  
Muni Rubens ◽  
Venkataraghavan Ramamoorthy ◽  
Anshul Saxena ◽  
Emir Veledar ◽  
Peter McGranaghan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Systemic Therapy ◽  
Kidney Injury ◽  
Unknown Origin ◽  
The United States ◽  
Urgent Care ◽  
Coordinated Care ◽  
Hospitalization Rates ◽  
Management Of Complications

7078 Background: Management of complications of systemic therapy for cancer involves significant healthcare burden for both patients and healthcare system. Aim of this study is to estimate trends as well as burden associated with these hospitalizations, using a nationally representative data. Methods: National Inpatient Sample data during 2005-2016 was used to identify complications of systemic therapy using ICD-9 and ICD-10 external cause of injury codes. Primary outcome was hospitalization rate while secondary outcomes were cost and in-hospital mortality related to these complications. Results: There were 443,222,223 hospitalizations recorded during the study period, of which 2,419,722 were due to complications of systemic therapy. The average annual percentage change of these hospitalizations was 8.1%, compared to -0.5% for general hospitalizations. The 3 most common causes for hospitalization were anemia (12.8%), neutropenia (10.8%), and sepsis (7.8%). During the study period, hospitalization rates had highest relative increases for sepsis (1.9 fold) and acute kidney injury (1.6 fold) and highest relative decrease for dehydration (0.21 fold) and fever of unknown origin (0.35 fold). Complications responsible for highest costs per hospitalization were sepsis ($16,834), acute kidney injury ($13,172), and pneumonia ($13,040). Leading causes of in-hospital mortality associated with systemic therapy were sepsis (15.8%), pneumonia (7.6%), and acute kidney injury (7.0%). Conclusions: During 2005-2016, hospitalization rates for systemic therapy complications increased by an annual rate of 8.1%, with anemia, neutropenia, and sepsis as the most common complications requiring hospitalization. Initiatives such as rule OP-35 by the Centers for Medicare and Medicaid Service, improving access and providing coordinated care, early identification and management of symptoms, and expanding urgent care access could decrease these hospitalizations and the burden on healthcare. [Table: see text]

scholarly journals Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States

Diseases ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 28
Author(s):  
Charat Thongprayoon ◽  
Fawad Qureshi ◽  
Tananchai Petnak ◽  
Wisit Cheungpasitporn ◽  
Api Chewcharat ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Resource Utilization ◽  
Hospital Admissions ◽  
Heat Stroke ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
The United States

This study aims to evaluate the risk factors and the association of acute kidney injury with treatments, complications, outcomes, and resource utilization in patients hospitalized for heat stroke in the United States. Hospitalized patients from years 2003 to 2014 with a primary diagnosis of heat stroke were identified in the National Inpatient Sample dataset. End stage kidney disease patients were excluded. The occurrence of acute kidney injury during hospitalization was identified using the hospital diagnosis code. The associations between acute kidney injury and clinical characteristics, in-hospital treatments, outcomes, and resource utilization were assessed using multivariable analyses. A total of 3346 hospital admissions were included in the analysis. Acute kidney injury occurred in 1206 (36%) admissions, of which 49 (1.5%) required dialysis. The risk factors for acute kidney injury included age 20–39 years, African American race, obesity, chronic kidney disease, congestive heart failure, and rhabdomyolysis, whereas age <20 or ≥60 years were associated with lower risk of acute kidney injury. The need for mechanical ventilation and blood transfusion was higher when acute kidney injury occurred. Acute kidney injury was associated with electrolyte and acid-base derangements, sepsis, acute myocardial infarction, ventricular arrhythmia or cardiac arrest, respiratory, circulatory, liver, neurological, hematological failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher in acute kidney injury patients. Approximately one third of heat stroke patients developed acute kidney injury during hospitalization. Acute kidney injury was associated with several complications, and higher mortality and resource utilization.

scholarly journals Hospital Mortality in the United States following Acute Kidney Injury

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Jeremiah R. Brown ◽  
Michael E. Rezaee ◽  
Emily J. Marshall ◽  
Michael E. Matheny
Keyword(s):  
United States ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Kidney Injury ◽  
The United States ◽  
The World ◽  
Hospital Deaths ◽  
Related Mortality ◽  
Temporal Incidence

Acute kidney injury (AKI) is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding) or improvements to the management of AKI.

Weekend Versus Weekday Mortality for Thrombotic Thrombocytopenic Purpura (TTP) Related Hospitalizations in the United States: Data from the National Inpatient Sample

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4863-4863
Author(s):  
Smith Giri ◽  
Ranjan Pathak ◽  
Madan Raj Aryal ◽  
Paras Karmacharya ◽  
Michael G Martin
Keyword(s):  
United States ◽  
Acute Kidney Injury ◽  
Relative Risk ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
The United States ◽  
P Value ◽  
Adjusted Relative Risk ◽  
Hospital Type ◽  
Thrombocytopenic Purpura

Abstract Introduction: Previous research has shown that weekend hospital admissions are associated with an increased mortality in comparison to weekday admissions for a number of emergent conditions including myocardial infarction [Relative Risk (RR) 1.048; 95% confidence interval [CI], 1.022 to 1.076; P value <0.001], pulmonary embolism (RR 1.17, 95% CI 1.03 to 1.34, P value <0.01) and gastrointestinal hemorrhage (RR 1.17, 95% CI 1.03 to 1.34, P value <0.01) . Thrombotic Thrombocytopenic Purpura (TTP) is a hematological emergency with a significant morbidity and mortality if not recognized early. However, studies evaluating if a similar "weekend" effect exists in TTP are lacking. Methods: We used the Nationwide Inpatient Sample database to identify patients admitted with TTP in the United States using ICD 9 CM code 446.6 from 2009 to 2011. Baseline data for demographic variables, age, gender, race, hospital characteristics- region, hospital type (rural versus urban, teaching versus non-teaching), bed-size, insurance payer and comorbidities were derived for weekend and weekday admissions. Logistic regression analysis was used to calculate the adjusted relative risk of in-hospital mortality of weekend versus weekday admissions. Data analysis was done using STATA 13.0 (College Station, TX: StataCorp LP) Results: Of the 6634, estimated TTP related hospitalizations, 19.5 % were admitted on the weekends and 80.5 % admitted on the weekdays. The mean age was 48±0.5 years and 66.4 % were females. A higher in-hospital mortality rate was seen among weekend admissions as compared to weekday admissions (RR 1.32, 95% CI 1.30-1.33, p value <0.01). On multivariate analysis (table 1), weekend admission remained as an independent predictor of increased mortality (adjusted RR 1.16, 95% CI 1.15-1.17, P value <0.01) after adjusting for other confounders including age, gender, comorbidities, hospital type and size. Similarly, acute kidney injury (adjusted RR 3.41, 95% CI 3.34-3.43, P value <0.001), stroke (adjusted RR 5.46, 95% CI 5.31-5.62, P value <0.001), and sepsis (adjusted RR 6.57, 95% CI 6.40-6.75, Pvalue <0.001) were associated with significantly increased risk of mortality among patients with TTP (table 1). Conclusions: A significantly higher in-hospital mortality occurs among TTP patients admitted on the weekends as compared to weekdays. Future research should focus on identifying the underlying factors for this difference so that quality improvement measures could be taken to mitigate this difference. Table 1: Logistic Regression Analysis showing the adjusted relative risk (RR) of various patient and hospital characteristics in predicting in-hospital mortality for patients with TTP. Variable Adjusted RR 95% CI of Adjusted RR P value Weekend admission 1.16 1.15-1.17 <0.001 Pay - Medicare - Medicaid - Private including HMO - self-pay - no charge - other 1.0 1.33 1.19 1.63 1.36 2.02 .. 1.28-1.38 1.14-1.25 1.50-1.77 1.11-1.67 1.73-2.36 <0.001 <0.001 <0.001 <0.001 <0.001 Race - white - black - hispanic - asian or pacific islander - native american - other 1.0 1.01 0.93 1.13 1.05 1.07 0.98-1.03 0.89-0.97 1.07-1.19 0.94-1.16 1.02-1.13 0.47 0.003 <0.001 0.34 0.003 Region - Northeast -Midwest - South - West 1 0.92 1.05 0.97 0.86-0.98 0.99-1.11 0.91-1.04 0.01 0.06 0.48 Co-morbidities - smoking - obesity - dyslipidemia - hypertension - diabetes mellitus - peripheral vascular disease - coronary artery disease - acute kidney injury - chronic kidney disease - stroke - sepsis 0.90 0.78 0.60 0.68 0.99 1.32 1.06 3.41 1.10 5.46 6.57 0.88-0.92 0.76-0.79 0.59-0.61 0.67-0.69 0.97-1.00 1.29-1.34 1.05-1.07 3.34-3.43 1.08-1.11 5.31-5.62 6.40-6.75 <0.001 <0.001 <0.001 <0.001 0.12 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 Age 1.04 1.043-1.046 <0.001 Female 0.78 0.78-0.79 <0.001 Hospital Type - rural - urban non teaching - urban teaching 1.0 0.92 1.05 0.88-0.97 0.99-1.11 0.002 0.061 Bed size - small - medium - large 0.95 1.01 0.89-1.01 0.96-1.07 0.11 0.51 Disclosures No relevant conflicts of interest to declare.

scholarly journals Hospitalization rates for complications due to systemic therapy in the United States

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anshul Saxena ◽  
Muni Rubens ◽  
Venkataraghavan Ramamoorthy ◽  
Raees Tonse ◽  
Emir Veledar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Systemic Therapy ◽  
Kidney Injury ◽  
Unknown Origin ◽  
The United States ◽  
Urgent Care ◽  
Coordinated Care ◽  
Hospitalization Rates ◽  
Nationally Representative

AbstractThe aim of this study was to estimate the trends and burdens associated with systemic therapy-related hospitalizations, using nationally representative data. National Inpatient Sample data from 2005 to 2016 was used to identify systemic therapy-related complications using ICD-9 and ICD-10 external causes-of-injury codes. The primary outcome was hospitalization rates, while secondary outcomes were cost and in-hospital mortality. Overall, there were 443,222,223 hospitalizations during the study period, of which 2,419,722 were due to complications of systemic therapy. The average annual percentage change of these hospitalizations was 8.1%, compared to − 0.5% for general hospitalizations. The three most common causes for hospitalization were anemia (12.8%), neutropenia (10.8%), and sepsis (7.8%). Hospitalization rates had the highest relative increases for sepsis (1.9-fold) and acute kidney injury (1.6-fold), and the highest relative decrease for dehydration (0.21-fold) and fever of unknown origin (0.35-fold). Complications with the highest total charges were anemia ($4.6 billion), neutropenia ($3.0 billion), and sepsis ($2.5 billion). The leading causes of in-hospital mortality associated with systemic therapy were sepsis (15.8%), pneumonia (7.6%), and acute kidney injury (7.0%). Promoting initiatives such as rule OP-35, improving access to and providing coordinated care, developing systems leading to early identification and management of symptoms, and expanding urgent care access, can decrease these hospitalizations and the burden they carry on the healthcare system.

scholarly journals 10-Year Trends in Aortic Dissection: Mortality and Weekend Effect within the US Nationwide Emergency Department Sample (NEDS)

2021 ◽  
Vol 24 (2) ◽  
pp. E336-E344
Author(s):  
James Brown ◽  
Bushra Usmani ◽  
George Arnaoutakis ◽  
Derek Serna-Gallegos ◽  
Konstadinos Plestis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
The United States ◽  
Weekend Effect ◽  
Discharge Data ◽  
The Us ◽  
The Impact

Background: This study examined changes in aortic dissection (AD) mortality from 2006 to 2017 and assessed the impact of weekday versus weekend presentation upon mortality. Methods: This observational study analyzed all records in the Nationwide Emergency Department Sample (NEDS) database. NEDS aggregates discharge data from 984 hospitals in 36 states and the District of Columbia in the United States of America. All patients with thoracic and thoracoabdominal AD recorded as their principal diagnosis were identified via ICD codes. Results: Patient characteristics (weekday|weekend) count: 26,759|9,640, P = 0.016; age (years): 65.2 ± 15.8|64.7 ± 16.2, P = 0.016; women: 11,318 (42.3%)|4,086 (42.4), P = 0.883; Charlson comorbidity index: 2.3 ± 1.7|2.3 ± 1.6, P = 0.025. There were 36,399 ED visits with diagnosed AD. Annual AD diagnoses increased by 70% from 2006 to 2017. From 2012-2017, patients had lower in-hospital mortality (9.9% versus 11.9%, P < 0.001) compared with 2006-2011. Patients reporting during the weekend had higher in-hospital mortality (11.8% versus 10.4%, P < 0.001) compared with weekdays. On multivariable analysis, year of presentation remained independently associated with in-hospital mortality, with 2012-2017 being associated with reduced mortality (odds ratio (OR) 0.90, 95% CI: 0.82, 0.99, P = 0.031), as compared with 2006-2011. Weekend presentation remained independently associated with worse in-hospital mortality (OR 1.17, 95% CI: 1.05, 1.29, P = 0.003) compared with weekday presentation. Conclusion: Although AD mortality is decreasing, the patients presenting on the weekend were 13% more likely to die in the hospital compared with patients presenting during the week.

Abstract 17300: Acute Kidney Injury is Associated With High Mortality in Patients With Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Siva Harsha Yedlapati ◽  
Usman Younus ◽  
Scott H Stewart
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
High Mortality ◽  
Mortality Risk ◽  
Odds Ratio ◽  
Kidney Injury ◽  
The United States ◽  
Factors Associated

Introduction: The prevalence of atrial fibrillation (AF) is high in patients with chronic kidney disease (CKD). The mortality risk of AF in the presence of CKD is also significantly high. Multiple theories of which importantly, the renin-angiotensin-aldosterone system activation causing increased ventricular remodeling and heart failure, explain the increased incidence of AF in CKD. However, there are no data available on the effects of acute kidney injury (AKI) on mortality in patients with AF. We sought to investigate the prevalence and association of AKI with in-hospital mortality in patients presenting with AF. Methods: We performed a cross-sectional analysis of the 2011 Nationwide Inpatient Sample (NIS). Using logistic regression methods appropriate for the NIS sample design, we estimated the mortality risk associated with AKI in AF patients and evaluated factors that might modify this association. Results: In 2011, AF accounted for 457662 (1.4%) of overall adult admissions in the United States with an in-hospital mortality rate of 1%. Among these hospitalizations 30894 (6.8%) had a concomitant AKI diagnosis. The prevalence of AKI was higher (38%) in patients who died during these AF hospitalizations. The mortality risk in AF hospitalizations with an AKI diagnosis remained high even after adjusting for factors associated with AKI including age, sex, CKD, sepsis, hypertension, diabetes, congestive heart failure (CHF), smoking and heavy alcohol use (odds ratio 5.6; 95% CI (4.7 - 6.6); P<0.0001), relative to patients hospitalized with a non-AF diagnoses (odds ratio 3.3; 95% CI (3.2 - 3.4). The factors that interacted with AKI in predicting mortality risk in AF hospitalizations were underlying CKD, CHF, diabetes and alcoholism. Conclusion: Among hospitalized patients with AF, AKI is associated with significantly high mortality. This mortality was higher when compared to patients hospitalized with a non-AF diagnosis. Interpretation of our results must be conservative given the study design and data limitations. Future research using primary data sources might help identify factors associated with increased mortality in AKI patients presenting with AF.

Acute kidney injury in childhood cancer: An insight from Kids' Inpatient Database.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18379-e18379
Author(s):  
Eman M Elsabbagh ◽  
Shireen Hashmat
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Healthcare Cost ◽  
Pediatric Oncology ◽  
Myeloid Leukemia ◽  
Kidney Injury ◽  
The United States ◽  
Oncology Patients ◽  
Common Diagnosis ◽  
Total Charges

e18379 Background: Oncology patients are at high risk for Acute Kidney Injury (AKI). AKI may occur due to direct injury from primary cancer, nephrotoxic effects of chemotherapy, hematopoietic stem-cell transplantation or following comorbidities like sepsis and metabolic disturbance. AKI is associated with prolonged hospital stay, high healthcare cost and increased mortality in critically ill patients. Despite the increased risk and these associations, the national rate and clinical outcome of AKI among pediatric oncology patients is not well described. Objective: Define AKI incidence and health outcomes among pediatric oncology patients in the United States (U.S.). Methods: We performed a retrospective cohort analysis of the Health Cost and Utilization Project (HCUP) Kids’ Inpatient 2000-2012 Database (KID) for patient ≤ 20 years of age. Patients with principal diagnosis of acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), lymphomas (Hodgkin and non-Hodgkin), brain tumor, neuroblastoma, bone tumors (Ewing’s Sarcoma and Osteosarcoma) and hepatoblastoma were reviewed. Encounters for chemotherapy were excluded. Patients with medical diagnosis of AKI were identified using ICD-9-CM codes. We performed descriptive statistics to characterize the cohort in terms of demographic factors (age, race, sex, insurance type), hospital characteristics and comorbidities. Data weights were applied to sampled patients to provide national estimates. The in-hospital mortality rate, total charges, and hospital length of stay (LOS) were compared between cancer patients with and without AKI using bivariable analyses. Results: A total of 266,113 admissions were included for analysis. The cohort was comprised of 4,761 patients with AKI, with an overall incidence 18 per 1,000 admissions. The median age was 13 years. Males (58.45%), and whites (55.4%) were more commonly affected. South and west regions (59%) of the U.S. had higher frequency of AKI. AML was the most common diagnosis associated with AKI (4.1%). Patients with AKI had significantly higher mortality rates (21.78% vs. 1.36%, p < 0.0001), longer median LOS (15 days vs. 4 days, p < 0.0001) and higher median total charges per hospitalization ($132,712 vs $18,856) when compared to patients without AKI. Conclusions: AKI in pediatric oncology patients is significantly associated with increased in-hospital mortality, LOS, and higher healthcare cost in pediatric oncology patients. This area needs focused research and quality improvement initiatives.

Review of the Literature on the Costs Associated With Acute Kidney Injury

2019 ◽  
Vol 32 (3) ◽  
pp. 292-302 ◽  
Author(s):  
Joseph F. Dasta ◽  
Sandra Kane-Gill
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Economic Impact ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Kidney Injury ◽  
The United States ◽  
Patient Specific ◽  
Major Surgery ◽  
Total Hospital

Acute kidney injury (AKI) develops in 8% to 16% of hospital admissions. These patients exhibit a 4- to 10-fold increase in mortality and prolonged hospital stays. There is a dearth of information on the economics of AKI, especially in critically ill patients whose health-care costs are already high. It is important that pharmacists understand the economic impact of AKI to optimally prevent and treat AKI occurrence, thus reducing total hospital costs. Authors used MEDLINE, PubMed, and Google Scholar searches up to April 2019. Inpatient AKI affects an estimated 498 000 patients in the United States with its annual cost from $4.7 to $24.0 billion. Average patient costs of AKI in the intensive care unit are generally double than those of non-AKI patients. High AKI severity portends a higher cost. Total hospital costs in patients with AKI ranged from $29 700 in cardiac surgery patients to $80 400 in cardiogenic shock. Incremental increases of cost range from $9400 in major surgery patients and up to $81 000 in nonsurviving dialysis patients. The enormity of the clinical and economic impact of AKI should be a call to action by pharmacists to expeditiously select patient-specific therapies to prevent and treat AKI, and thus reduce its economic burden on an already fragile health-care system.

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