title: Acute kidney injury treated with renal replacement therapy and 5-year mortality after myocardial infarction-related cardiogenic shock: a nationwide population-based cohort study.
abstract: BACKGROUND
  Myocardial infarction-related cardiogenic shock is frequently complicated by acute kidney injury. We examined the influence of acute kidney injury treated with renal replacement therapy (AKI-RRT) on risk of chronic dialysis and mortality, and assessed the role of comorbidity in patients with cardiogenic shock.
  
  
  METHODS
  In this Danish cohort study conducted during 2005-2012, we used population-based medical registries to identify patients diagnosed with first-time myocardial infarction-related cardiogenic shock and assessed their AKI-RRT status. We computed the in-hospital mortality risk and adjusted relative risk. For hospital survivors, we computed 5-year cumulative risk of chronic dialysis accounting for competing risk of death. Mortality after discharge was computed with use of Kaplan-Meier methods. We computed 5-year hazard ratios for chronic dialysis and death after discharge, comparing AKI-RRT with non-AKI-RRT patients using a propensity score-adjusted Cox regression model.
  
  
  RESULTS
  We identified 5079 patients with cardiogenic shock, among whom 13% had AKI-RRT. The in-hospital mortality was 62% for AKI-RRT patients, and 36% for non-AKI-RRT patients. AKI-RRT remained associated with increased in-hospital mortality after adjustment for confounders (relative risk=1.70, 95% confidence interval (CI): 1.59-1.81). Among the 3059 hospital survivors, the 5-year risk of chronic dialysis was 11% (95% CI: 8-16%) for AKI-RRT patients, and 1% (95% CI: 0.5-1%) for non-AKI-RRT patients (adjusted hazard ratio: 15.9 (95% CI: 8.7-29.3). The 5-year mortality was 43% (95% CI: 37-53%) for AKI-RRT patients compared with 29% (95% CI: 29-31%) for non-AKI-RRT patients. The adjusted 5-year hazard ratio for death was 1.55 (95% CI: 1.22-1.96) for AKI-RRT patients compared with non-AKI-RRT patients. In patients with comorbidity, absolute mortality increased while relative impact of AKI-RRT on mortality decreased.
  
  
  CONCLUSIONS
  AKI-RRT following myocardial infarction-related cardiogenic shock predicted elevated short-term mortality and long-term risk of chronic dialysis and mortality. The impact of AKI-RRT declined with increasing comorbidity suggesting that intensive treatment of AKI-RRT should be accompanied with optimized treatment of comorbidity when possible.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. mala_mdl@hotmail.com.|California Pacific Medical Institute Research Institute, 475 Brannan, Suite 220, San Francisco, CA, 94107, USA. mala_mdl@hotmail.com.
authors.forename: Marie Dam
authors.initials: MD
authors.lastname: Lauridsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. hg@clin.au.dk.|Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200, Aarhus N, Denmark. hg@clin.au.dk.
authors.forename: Henrik
authors.initials: H
authors.lastname: Gammelager
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. morten.schmidt@clin.au.dk.|Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200, Aarhus N, Denmark. morten.schmidt@clin.au.dk.
authors.forename: Morten
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. tbr@clin.au.dk.
authors.forename: Thomas Bøjer
authors.initials: TB
authors.lastname: Rasmussen
authors.affiliation: Division of Cardiology, California Pacific Medical Center, 2200 Webster Street, San Francisco, CA, 94115, USA. ShawR@sutterhealth.org.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200, Aarhus N, Denmark. heb@dadlnet.dk.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. hts@clin.au.dk.
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. cfc@clin.au.dk.
authors.forename: Christian Fynbo
authors.initials: CF
authors.lastname: Christiansen
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003956:Dialysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012770:Shock, Cardiogenic / Q000150:complications* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality