Trends and Predictors of Acute Kidney Injury in Patients with and without Chronic Kidney Disease Undergoing Left Ventricular Assist Device Implantation: A Nationwide Inpatient Sample Analysis

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; p. S236
• Main Authors: Ranka, S., Pahuja, M., Mony, S., Akhtar, T., Chahab, O., Abubakar, H., Yassen, A., Ando, T., Alvarez, P., Afonso, L., Brisoulis, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.581

Acute Kidney Injury (AKI) is known to be associated with poor outcomes in patients undergoing Left ventricular assist device (LVAD) implantation. We sought to determine the trends and predictors of AKI in this patient population.
We queried the National Inpatient Sample (NIS) from Jan 2006 to Sept 2015 database for patients undergoing LVAD implantation using ICD-9 codes We excluded all the patients with end-stage renal disease. We divided the study sample into two cohorts 1. AKI with Chronic Kidney Disease (CKD) (A-CKD) 2. AKI without CKD (A-NCKD) and analyzed separately. Baseline characteristics and outcomes were identified using appropriate ICD-9 codes. Temporal trends of AKI were graphed, and regression analysis was done to identify comorbidities and social predictors of AKI in both the cohorts.
There was significant uptrend in incidence of AKI in A-CKD cohort (from 41.7% in 2006 to 76.4% in 2015; p<0.001) but no such trend was observed in the A-NCKD patients. Advancing age, female gender, hypertension, vasopressors use and infections are associated with increased risk of AKI regardless of baseline CKD (all p< 0.05). In A-CKD group the presence of peripheral arterial disease, coronary artery disease, cardiogenic shock and post procedural bleeding requiring transfusion were additional risk factors for AKI (all p< 0.05). Similarly, in A-NCKD, the presence of diabetes, chronic pulmonary disease, pulmonary hypertension, acute in-hospital stroke, ventricular fibrillation and cirrhosis increased risk of AKI (all p< 0.05).
In last decade, there has been a significant uptrend in AKI in patients with CKD. The rate of AKI in the patients without baseline CKD remained stable.