Jeremiah R Brown1, William M Hisey2, Emily J Marshall2, Donald S Likosky3, Elizabeth L Nichols2, Allen D Everett4, Sara K Pasquali5, Marshall L Jacobs6, Jeff P Jacobs7, Chirag R Parikh8. 1. Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Lebanon, New Hampshire. Electronic address: jbrown@dartmouth.edu. 2. Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire. 3. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 4. Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland. 5. Department of Pediatrics and Communicable Diseases, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan. 6. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland. 7. Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Florida. 8. Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, Temple Medical Center, New Haven, Connecticut.
Abstract
BACKGROUND: Acute kidney injury (AKI) is a common complication after cardiac surgery. While AKI severity is known to be associated with increased risk of short-term outcomes, its long-term impact is less well understood. METHODS: Adult patients undergoing isolated coronary artery bypass graft surgery at eight centers were enrolled into the Northern New England biomarker registry (n = 1,610). Patients were excluded if they had renal failure (n = 15) or died during index admission (n = 38). Severity of AKI was defined using the Acute Kidney Injury Network (AKIN). We linked our cohort to national Medicare and state all-payer claims to ascertain readmissions and to the National Death Index to ascertain survival. Kaplan-Meier and multivariate Cox proportional hazards modeling was conducted for time to readmission and death over 5 years. RESULTS: Within 5 years, 513 patients (33.8%) had AKI with AKIN stage 1 (29.9%) and stage 2 to 3 (3.9%). There were 620 readmissions (39.9%) and 370 deaths (23.8%). After adjustment, stage 1 AKI patients had a 31% increased risk of readmission (95% confidence interval [CI]: 1.10 to 1.57), whereas stage 2 or 3 patients had a 98% increased risk (95% CI: 1.41 to 2.78) compared with patients having no AKI. Relative to patients without AKI, stage 1 patients had a 56% increased risk of mortality (95% CI: 1.14 to 2.13), whereas stage 2 or 3 patients had a 3.5 times higher risk (95% CI: 2.16 to 5.60). CONCLUSIONS: Severity of AKI using the AKIN stage criteria is associated with a significantly increased risk of 5-year readmission and mortality. Our findings suggest that efforts to reduce AKI in the perioperative period may have a significant long-term impact on patients and payers in reducing mortality and health care utilization.
BACKGROUND:Acute kidney injury (AKI) is a common complication after cardiac surgery. While AKI severity is known to be associated with increased risk of short-term outcomes, its long-term impact is less well understood. METHODS: Adult patients undergoing isolated coronary artery bypass graft surgery at eight centers were enrolled into the Northern New England biomarker registry (n = 1,610). Patients were excluded if they had renal failure (n = 15) or died during index admission (n = 38). Severity of AKI was defined using the Acute Kidney Injury Network (AKIN). We linked our cohort to national Medicare and state all-payer claims to ascertain readmissions and to the National Death Index to ascertain survival. Kaplan-Meier and multivariate Cox proportional hazards modeling was conducted for time to readmission and death over 5 years. RESULTS: Within 5 years, 513 patients (33.8%) had AKI with AKIN stage 1 (29.9%) and stage 2 to 3 (3.9%). There were 620 readmissions (39.9%) and 370 deaths (23.8%). After adjustment, stage 1 AKI patients had a 31% increased risk of readmission (95% confidence interval [CI]: 1.10 to 1.57), whereas stage 2 or 3 patients had a 98% increased risk (95% CI: 1.41 to 2.78) compared with patients having no AKI. Relative to patients without AKI, stage 1 patients had a 56% increased risk of mortality (95% CI: 1.14 to 2.13), whereas stage 2 or 3 patients had a 3.5 times higher risk (95% CI: 2.16 to 5.60). CONCLUSIONS: Severity of AKI using the AKIN stage criteria is associated with a significantly increased risk of 5-year readmission and mortality. Our findings suggest that efforts to reduce AKI in the perioperative period may have a significant long-term impact on patients and payers in reducing mortality and health care utilization.
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