title: Effect of Transient and Sustained Acute Kidney Injury on Readmissions in Acute Decompensated Heart Failure.
abstract: Although acute kidney injury (AKI) is common in heart failure, yet the impact of the onset, timing, and duration of AKI on short-term outcomes is not well studied. AKI was defined as an increase in serum creatinine SCr of ≥0.3 mg/dl or 1.5 times relative to the admission and further categorized as transient AKI (T-AKI: SCr returning to within 10% of baseline); sustained AKI (S-AKI: those with at least 72 hours of hospital stay and did not meet T-AKI); and unknown duration AKI (U-AKI: those with less than 72 hours stay and did not meet T-AKI). Reference category was no AKI (stable or <0.3 mg/dl change in SCr). The main outcome was 30-day all-cause hospital readmission. Unadjusted and adjusted association between AKI category of interest and main outcome was represented as percent and relative risks with 95% CIs. Statistical significance was set at an alpha of 0.05. From the Cerner Health Facts sample, 14,017 of 22,059 available subjects met the eligibility criteria. Approximately, 19.2% of our sample met the primary outcome. Compared with no AKI (readmission rate of 17.7%; 95% CI 16.4% to 18.9%), the adjusted rate of readmission was highest in patients with S-AKI (22.8%, 95% CI 20.8% to 24.8%; p <0.001), followed by 20.2% (95% CI 17.5% to 22.8%; p = 0.05) in T-AKI patients. Compared with no AKI, the adjusted relative risk of 30-day readmission was 1.29 (95% CI 1.17 to 1.42), 1.14 (95% CI 1.00 to 1.31), and 1.12 (95% CI, 1.01 to 1.26) in S-AKI, T-AKI, and U-AKI, respectively. In conclusion, both sustained AKI and patients with transient elevation still remain at a higher risk of readmission within 30 days. Future studies should focus on examining process-of-care after discharge in patients with different patterns of AKI.
authors.affiliation: Department of Medicine, Baystate Wing Hospital, Palmer, Massachusetts.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Freda
authors.affiliation: Division of Academic Affairs, Epidemiology/Biostatistics Research Core, Springfield, Massachusetts.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Knee
authors.affiliation: Department of Medicine, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Braden
authors.affiliation: Division of Academic Affairs, Epidemiology/Biostatistics Research Core, Springfield, Massachusetts.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Visintainer
authors.affiliation: Division of Nephrology, Kidney CARE Program, Cincinnati, Ohio; Cincinnati VA Medical Center, Cincinnati, Ohio. Electronic address: Charuhas.thakar@uc.edu.
authors.forename: Charuhas V
authors.initials: CV
authors.lastname: Thakar
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D003404:Creatinine