title: National Trends and Impact of Acute Kidney Injury Requiring Hemodialysis in Hospitalizations With Atrial Fibrillation.
abstract: Atrial fibrillation (AF) is a common cause for hospitalization, but there are limited data regarding acute kidney injury requiring dialysis (AKI-D) in AF hospitalizations. We aimed to assess temporal trends and outcomes in AF hospitalizations complicated by AKI-D utilizing a nationally representative database.
  
  
  
  Utilizing the Nationwide Inpatient Sample, AF hospitalizations and AKI-D were identified using diagnostic and procedure codes. Trends were analyzed overall and within subgroups and utilized multivariable logistic regression to generate adjusted odds ratios (aOR) for predictors and outcomes including mortality and adverse discharge. Between 2003 and 2012, 3751 (0.11%) of 3 497 677 AF hospitalizations were complicated by AKI-D. The trend increased from 0.3/1000 hospitalizations in 2003 to 1.5/1000 hospitalizations in 2012, with higher increases in males and black patients. Temporal changes in demographics and comorbidities explained a substantial proportion but not the entire trend. Significant comorbidities associated with AKI-D included mechanical ventilation (aOR 13.12; 95% CI 9.88-17.43); sepsis (aOR 8.20; 95% CI 6.00-11.20); and liver failure (aOR 3.72; 95% CI 2.92-4.75). AKI-D was associated with higher risk of in-hospital mortality (aOR 3.54; 95% CI 2.81-4.47) and adverse discharge (aOR 4.01; 95% CI 3.12-5.17). Although percentage mortality within AKI-D decreased over the decade, attributable risk percentage mortality remained stable.
  
  
  
  AF hospitalizations complicated by AKI-D have quintupled over the last decade with differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. Without effective AKI-D therapies, focus should be on early risk stratification and prevention to avoid this devastating complication.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Lili
authors.initials: L
authors.lastname: Chan
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Kinsuk
authors.initials: K
authors.lastname: Chauhan
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Priti
authors.initials: P
authors.lastname: Poojary
authors.affiliation: Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Sagar
authors.initials: S
authors.lastname: Patel
authors.affiliation: Boston University School of Medicine, Boston, MA.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Pawar
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ashish
authors.initials: A
authors.lastname: Correa
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Shanti
authors.initials: S
authors.lastname: Patel
authors.affiliation: UC San Diego, San Diego, CA.
authors.forename: Pranav S
authors.initials: PS
authors.lastname: Garimella
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Narender
authors.initials: N
authors.lastname: Annapureddy
authors.affiliation: University of Arkansas Medical Center, Little Rock, AR.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Umesh
authors.initials: U
authors.lastname: Gidwani
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY girish.nadkarni@mountsinai.org.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D017093:Liver Failure / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011158:Population Growth; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy; D018805:Sepsis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: acute kidney injury; atrial fibrillation; dialysis; mortality