title: Incidence and In-Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis-Requiring AKI (AKI-D) After Cardiac Catheterization in the National Inpatient Sample.
abstract: BACKGROUND
  Acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) are common, serious complications of cardiac procedures.
  
  
  RESULTS
  We evaluated 3 633 762 (17 765 214 weighted population) cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI-D in the United States from 2001 to 2011. Odds ratios for both conditions and associated in-hospital mortality were calculated for each year in the study period using multiple logistic regression. The number of cardiac catheterization or PCI cases resulting in AKI rose almost 3-fold from 2001 to 2011. The adjusted odds of AKI and AKI-D per year among cardiac catheterization and PCI patients were 1.11 (95% CI: 1.10-1.12) and 1.01 (95% CI: 0.99-1.02), respectively. Most importantly, in-hospital mortality significantly decreased from 2001 to 2011 for AKI (19.6-9.2%) and AKI-D (28.3-19.9%), whereas odds of associated in-hospital mortality were 0.50 (95% CI: 0.45-0.56) and 0.70 (95% CI: 0.55-0.93) in 2011 versus 2001, respectively. The population-attributable risk of mortality for AKI and AKI-D was 25.8% and 3.8% in 2001 and 41.1% and 6.5% in 2011, respectively. Males and females had similar patterns of AKI increase, although males outpaced females.
  
  
  CONCLUSIONS
  The Incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States, and this should be addressed by implementing prevention strategies. However, mortality has significantly declined, suggesting that efforts to manage AKI and AKI-D after cardiac catheterization and PCI have reduced mortality.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH jbrown@dartmouth.edu.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH Oakland University William Beaumont School of Medicine, Rochester, MI.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Rezaee
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Nichols
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Marshall
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Murfreesboro, TN Division of Nephrology, Department of Medicine, Vanderbilt Center for Kidney Disease (VKCD), Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Murfreesboro, TN Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Matheny
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: acute kidney injury; acute renal failure; glomerular filtration rate; renal failure