Contemporary trend of acute kidney injury incidence and incremental costs among US patients undergoing percutaneous coronary procedures

Abstract

Objectives: To assess national trends of acute kidney injury (AKI) incidence, incremental costs, risk factors, and readmissions among patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) during 2012-2017. Background: AKI remains a serious complication for patients undergoing CAG/PCI. Evidence is lacking in contemporary AKI trends and its impact on hospital resource utilization. Methods: Patients who underwent CAG/PCI procedures in 749 hospitals were identified from Premier Healthcare Database. AKI was defined by ICD-9/10 diagnosis codes (584.9/N17.9, 583.89/N14.1, 583.9/N05.9, E947.8/T50.8X5) during 7 days post index procedure. Multivariable regression models were used to adjust for confounders. Results: Among 2,763,681 patients, AKI incidence increased from 6.0 to 8.4% or 14% per year in overall patients; from 18.0 to 28.4% in those with chronic kidney disease (CKD) and from 2.4 to 4.2% in those without CKD (all p < .001). Significant risk factors for AKI included older age, being uninsured, inpatient procedures, CKD, anemia, and diabetes (all p < .001). AKI was associated with higher 30-day in-hospital mortality (OR adjusted = 2.55; 95% CI: 2.40, 2.70) and readmission risk

Association of acute kidney injury with outcomes in patients undergoing percutaneous left atrial appendage closure

“…Thirty‐day readmission rates are a healthcare system performance measure determined by the Centers for Medicare and Medicaid Services due to rising healthcare costs. Previous research demonstrated higher rates of 30‐day readmissions in patients with AKI in the setting of PCI and TMVr 16,26 . In this study, 30‐day readmission was higher in patients with AKI associated with LAAC (18.1 vs. 9.7%).…”

“…Previous research demonstrated higher rates of 30-day readmissions in patients with AKI in the setting of PCI and TMVr. 16,26 In this study, 30-day readmission was higher in patients with AKI associated with LAAC (18.1 vs. 9.7%). This higher rate of readmissions extended up to 180-days after discharge, with a large number of patients (45.7%) being readmitted after index discharge.…”

DyeVert Contrast Reduction System Use in Patients Undergoing Coronary and/or Peripheral Angiography: A Systematic Literature Review and Meta-Analysis

“…While beneficial for clinical interpretation and diagnosis, use of CM may result in adverse effects ( 1 ). One of the most important adverse effects associated with CM is contrast-associated acute kidney injury (CA-AKI) with incidence rates between 3 and 37% ( 2 – 6 ).…”

Development and Evaluation of an Audit and Feedback Process for Prevention of Acute Kidney Injury During Coronary Angiography and Intervention

“…Contrast-associated acute kidney injury (CA-AKI) is a preventable complication of coronary angiography and percutaneous coronary intervention (PCI), 1 , 2 , 3 , 4 that has increased in incidence in recent years, is associated with increased hospital length of stay, readmission, and adverse cardiovascular and kidney outcomes, and increases costs of care by US $7000-$9000 per patient. 5 , 6 , 7 , 8 Although evidence indicates that minimizing the volume of iodinated radiocontrast media 9 , 10 , 11 , 12 , 13 and optimizing delivery of intravenous (IV) hydration 14 , 15 , 16 can prevent CA-AKI in patients at risk, 17 , 18 , 19 these strategies are used inconsistently in current clinical care. 1 , 20 , 21 Relatively little research has been done to determine how to better integrate these CA-AKI prevention strategies into clinical practice.…”