Incremental Cost of Acute Kidney Injury after Percutaneous Coronary Intervention in the United States

Amin, Amit P.; McNeely, Christian; Spertus, John A.; Bach, Richard G.; Frogge, Nathan; Lindner, Samuel M.; Jain, Sudhir; Bradley, Steven M; Wasfy, Jason H.; Goyal, Abhinav; Maddox, Thomas M.; House, John A.; Kulkarni, Hemant; Masoudi, Frederick A.

doi:10.1016/j.amjcard.2019.09.042

Cited by 28 publications

(17 citation statements)

References 31 publications

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“…The estimates of AKI incidence in CKD patients are also on par with estimates using AKIN clinical definition 25 . The similarity between our estimates of AKI incidence and those from studies using AKIN clinical definition suggests that the diagnosis codes used in this contemporary dataset may be more robust than those reported in prior correlation studies 21,26 . Temporally linking an AKI event to a procedure in an administrative dataset can be challenging.…”

Section: Discussionmentioning

confidence: 58%

“…25 The similarity between our estimates of AKI incidence and those from studies using AKIN clinical definition suggests that the diagnosis codes used in this contemporary dataset may be more robust than those reported in prior correlation studies. 21,26 Temporally linking an AKI event to a procedure in an administrative dataset can be challenging. With respect to the timing of the AKI event, 88.2% of patients in the inpatient setting had CAG/PCI procedures done in the first 3 days of admission (68.1% were done on first day of admission), which suggests that the majority of patients likely developed AKI after the CAG/PCI procedures.…”

Section: An Analysis By Tsai Et Al Of Nationalmentioning

confidence: 99%

“…A recent study using Premier Healthcare Data (PHD) during 2006-2015 estimated that the average incremental cost of AKI post PCI procedures was $9,448 and the annual AKI cost burden was $411.3 million. 21 However, this study did not include CAG procedures or costs post-index visit. It also did not account for PCI procedures in an outpatient setting, which account for approximately half of all PCIs in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…These estimates are limited by a dated sample and also may not reflect the true cost of AKI due to the lack of comparison groups and uncontrolled confounders. A recent study using Premier Healthcare Data (PHD) during 2006–2015 estimated that the average incremental cost of AKI post PCI procedures was $9,448 and the annual AKI cost burden was $411.3 million 21 . However, this study did not include CAG procedures or costs post‐index visit.…”

Section: Introductionmentioning

confidence: 99%

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

Prasad

Rosenthal

Kartashov

et al. 2020

Cathet Cardio Intervent

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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

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Section: Discussionmentioning

confidence: 58%

Section: An Analysis By Tsai Et Al Of Nationalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Prasad

Rosenthal

Kartashov

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

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“…AKI was also independently associated with 3.6 more days of hospitalization (p < 0.001). Successful prevention of AKI after PCI may therefore significantly reduce medical costs [21]. CA-AKI is also related to the occurrence and development of CKD [22].…”

Section: Epidemiology and Disease Burdenmentioning

confidence: 99%

Contrast-associated acute kidney injury: An update of risk factors, risk factor scores, and preventive measures

et al. 2021

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Effect of Clinical Decision Support With Audit and Feedback on Prevention of Acute Kidney Injury in Patients Undergoing Coronary Angiography

James

Har

Tyrrell

et al. 2022

JAMA

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ImportanceContrast-associated acute kidney injury (AKI) is a common complication of coronary angiography and percutaneous coronary intervention (PCI) that has been associated with high costs and adverse long-term outcomes.ObjectiveTo determine whether a multifaceted intervention is effective for the prevention of AKI after coronary angiography or PCI.Design, Setting, and ParticipantsA stepped-wedge, cluster randomized clinical trial was conducted in Alberta, Canada, that included all invasive cardiologists at 3 cardiac catheterization laboratories who were randomized to various start dates for the intervention between January 2018 and September 2019. Eligible patients were aged 18 years or older who underwent nonemergency coronary angiography, PCI, or both; who were not undergoing dialysis; and who had a predicted AKI risk of greater than 5%. Thirty-four physicians performed 7820 procedures among 7106 patients who met the inclusion criteria. Participant follow-up ended in November 2020.InterventionsDuring the intervention period, cardiologists received educational outreach, computerized clinical decision support on contrast volume and hemodynamic-guided intravenous fluid targets, and audit and feedback. During the control (preintervention) period, cardiologists provided usual care and did not receive the intervention.Main Outcomes and MeasuresThe primary outcome was AKI. There were 12 secondary outcomes, including contrast volume, intravenous fluid administration, and major adverse cardiovascular and kidney events. The analyses were conducted using time-adjusted models.ResultsOf the 34 participating cardiologists who were divided into 8 clusters by practice group and center, the intervention group included 31 who performed 4327 procedures among 4032 patients (mean age, 70.3 [SD, 10.7] years; 1384 were women [32.0%]) and the control group included 34 who performed 3493 procedures among 3251 patients (mean age, 70.2 [SD, 10.8] years; 1151 were women [33.0%]). The incidence of AKI was 7.2% (310 events after 4327 procedures) during the intervention period and 8.6% (299 events after 3493 procedures) during the control period (between-group difference, −2.3% [95% CI, −0.6% to −4.1%]; odds ratio [OR], 0.72 [95% CI, 0.56 to 0.93]; P = .01). Of 12 prespecified secondary outcomes, 8 showed no significant difference. The proportion of procedures in which excessive contrast volumes were used was reduced to 38.1% during the intervention period from 51.7% during the control period (between-group difference, −12.0% [95% CI, −14.4% to −9.4%]; OR, 0.77 [95% CI, 0.65 to 0.90]; P = .002). The proportion of procedures in eligible patients in whom insufficient intravenous fluid was given was reduced to 60.8% during the intervention period from 75.1% during the control period (between-group difference, −15.8% [95% CI, −19.7% to −12.0%]; OR, 0.68 [95% CI, 0.53 to 0.87]; P = .002). There were no significant between-group differences in major adverse cardiovascular events or major adverse kidney events.Conclusions and RelevanceAmong cardiologists randomized to an intervention including clinical decision support with audit and feedback, patients undergoing coronary procedures during the intervention period were less likely to develop AKI compared with those treated during the control period, with a time-adjusted absolute risk reduction of 2.3%. Whether this intervention would show efficacy outside this study setting requires further investigation.Trial RegistrationClinicalTrials.gov Identifier: NCT03453996

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Incremental Cost of Acute Kidney Injury after Percutaneous Coronary Intervention in the United States

Cited by 28 publications

References 31 publications

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

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

Contrast-associated acute kidney injury: An update of risk factors, risk factor scores, and preventive measures

Effect of Clinical Decision Support With Audit and Feedback on Prevention of Acute Kidney Injury in Patients Undergoing Coronary Angiography

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