Characteristics and Outcomes of Patients With Cardiogenic Shock Utilizing Hemodialysis for Acute Kidney Injury

Abstract

In the setting of cardiogenic shock (CS), impaired biventricular function can cause acute decrease in renal function via reduced renal perfusion and increased renal venous pressure. We sought to analyze the characteristics and outcomes of patients hospitalized with CS who utilized renal replacement therapy (hemodialysis) for acute kidney injury (AKI-HD). We utilized data from the National Inpatient Sample to calculate national rates of in-hospital mortality, use of temporary mechanical support, vascular injury requiring surgery, length of stay (LOS) and hospitalization cost from 2010 to September 2015. We compared the in-hospital outcomes between CS with AKI-HD and a propensity score-matched group without AKI-HD. We identified 6,076 hospitalizations (weighted n = 24,272) with CS and AKI-HD and 76,878 (weighted n = 378,553) with CS not AKI-HD. Among these cases 48.1% (n = 39,403, weighted n = 193,746) had ST elevation myocardial infarction as the cause of CS. Patients with CS and AKI-HD had higher comorbidity burden and they were also more likely to receive mechanical circulatory support device (absolute standardized difference >10% for all comparisons) compared with CS patients without AKI-HD. After matching 4,457 cases for patient-level and hospital-level characteristics, CS with AKI-HD was associated with significantly higher in-hospital mortality (75.74% vs 51.58%, p <0.001), use of temporary mechanical support (24.0% vs 19.3%, p <0.001), LOS (21.4 vs14.4 days, p <0.001) and cost ($80,406 vs $52,833, p <0.0001). AKI-HD occurred in approximately 6% of patients with CS in years 2010 to 2015 and was associated with significantly increased in-hospital morbidity and mortality, LOS, and cost.