title: National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States.
abstract: OBJECTIVE
  Cirrhosis affects 5.5 million patients with estimated costs of US$4 billion. Previous studies about dialysis requiring acute kidney injury (AKI-D) in decompensated cirrhosis (DC) are from a single center/year. We aimed to describe national trends of incidence and impact of AKI-D in DC hospitalizations.
  
  
  METHODS
  We extracted our cohort from the Nationwide Inpatient Sample (NIS) from 2006-2012. We identified hospitalizations with DC and AKI-D by validated ICD9 codes. We analyzed temporal changes in DC hospitalizations complicated by AKI-D and utilized multivariable logistic regression models to estimate AKI-D impact on hospital mortality.
  
  
  RESULTS
  We identified a total of 3,655,700 adult DC hospitalizations from 2006 to 2012 of which 78,015 (2.1 %) had AKI-D. The proportion with AKI-D increased from 1.5 % in 2006 to 2.23 % in 2012; it was stable between 2009 and 2012 despite an increase in absolute numbers from 6773 to 13,930. The overall hospital mortality was significantly higher in hospitalizations with AKI-D versus those without (40.87 vs. 6.96 %; p < 0.001). In an adjusted multivariable analysis, adjusted odds ratio for mortality was 2.17 (95 % CI 2.06-2.28; p < 0.01) with AKI-D, which was stable from 2006 to 2012. Changes in demographics and increases in acute/chronic comorbidities and procedures explained temporal changes in AKI-D.
  
  
  CONCLUSIONS
  Proportion of DC hospitalizations with AKI-D increased from 2006 to 2009, and although this was stable from 2009 to 2012, there was an increase in absolute cases. These results elucidate the burden of AKI-D on DC hospitalizations and excess associated mortality, as well as highlight the importance of prevention, early diagnosis and testing of novel interventions in this vulnerable population.
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA. girish.nadkarni@mountsinai.org.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
authors.affiliation: Division of Gastroenterology and Nutrition, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Priya K
authors.initials: PK
authors.lastname: Simoes
authors.affiliation: Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA.
authors.forename: Shanti
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Nephrology, Department of Medicine, University of Buffalo School of Medicine, Buffalo, NY, USA.
authors.forename: Rabi
authors.initials: R
authors.lastname: Yacoub
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Konstantinidis
authors.affiliation: Division of Critical Care, Department of Medicine, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kamat
authors.affiliation: Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Narender
authors.initials: N
authors.lastname: Annapureddy
authors.affiliation: Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Acute kidney injury; Cirrhosis; Dialysis; Mortality
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