Dialysis Requiring Acute Kidney Injury in Acute Cerebrovascular Accident Hospitalizations.
OBJECTIVE
The epidemiology of dialysis requiring acute kidney injury (AKI-D) in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) admissions is poorly understood with previous studies being from a single center or year.


METHODS
We used the Nationwide Inpatient Sample to evaluate the yearly incidence trends of AKI-D in hospitalizations with AIS and ICH from 2002 to 2011. We also evaluated the trend of impact of AKI-D on in-hospital mortality and adverse discharge using adjusted odds ratios (aOR) after adjusting for demographics and comorbidity indices.


RESULTS
We extracted a total of 3,937,928 and 696,754 hospitalizations with AIS and ICH, respectively. AKI-D occurred in 1.5 and 3.5 per 1000 in AIS and ICH admissions, respectively. Incidence of admissions complicated by AKI-D doubled from 0.9/1000 to 1.7/1000 in AIS and from 2.1/1000 to 4.3/1000 in ICH admissions. In AIS admissions, AKI-D was associated with 30% higher odds of mortality (aOR, 1.30; 95% confidence interval, 1.12-1.48; P<0.001) and 18% higher odds of adverse discharge (aOR, 1.18; 95% confidence interval, 1.02-1.37; P<0.001). Similarly, in ICH admissions, AKI-D was associated with twice the odds of mortality (aOR, 1.95; 95% confidence interval, 1.61-2.36; P<0.01) and 74% higher odds of adverse discharge (aOR, 1.74; 95% confidence interval, 1.34-2.24; P<0.01). Attributable risk percent of mortality was high with AKI-D (98%-99%) and did not change significantly over the study period.


CONCLUSIONS
Incidence of AKI-D complicating hospitalizations with cerebrovascular accident continues to grow and is associated with increased mortality and adverse discharge. This highlights the need for early diagnosis, better risk stratification, and preparedness for need for complex long-term care in this vulnerable population.
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Girish N
GN
Nadkarni
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Achint A
AA
Patel
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Ioannis
I
Konstantinidis
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Abhimanyu
A
Mahajan
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Shiv Kumar
SK
Agarwal
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Sunil
S
Kamat
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Narender
N
Annapureddy
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.).
Alexandre
A
Benjo
From the Division of Nephrology, Department of Medicine (G.N.N., I.K.) and Department of Public Health (A.A.P.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Henry Ford Hospital System, Detroit, MI (A.M.); Division of Cardiology, Department of Medicine, University of Arkansas Medical Center, Little Rock (S.K.A.); Division of Critical Care, Department of Medicine, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India (S.K.); Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (N.A.); Division of Cardiology, Department of Medicine, Oschner Clinic Foundation, New Orleans, LA (A.B.); and Division of Nephrology, Department of Medicine, University of Cincinnati and Renal Section, Cincinnati VA Medical Center, OH (C.V.T.). charuhas.thakar@uc.edu.
Charuhas V
CV
Thakar
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000628:therapy; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology
epidemiology; hospitalization; kidney; mortality; stroke