Rationale & Objective

Ventricular assist devices (VADs) are used for end-stage heart failure not amenable to medical therapy. Acute kidney injury (AKI) in this setting is common due to heart failure decompensation, surgical stress, and other factors. Little is known about national trends in AKI diagnosis and AKI requiring dialysis (AKI-D) and associated outcomes with VAD implantation. We investigated national estimates and trends for diagnosed AKI, AKI-D, and associated patient and resource utilization outcomes in hospitalizations in which implantable VADs were placed.

Study Design

Cohort study of 20% stratified sample of US hospitalizations.

Setting & Participants

Patients who underwent implantable VAD placement in 2006 to 2015.

Exposure

No AKI diagnosis, AKI without dialysis, AKI-D.

Outcomes

In-hospital mortality, length of stay, estimated hospitalization costs.

Analytical Approach

Multivariate logistic and linear regression using survey design methods to account for stratification, clustering, and weighting.

Results

An estimated 24,140 implantable VADs were placed, increasing from 853 in 2006 to 3,945 in 2015. AKI was diagnosed in 56.1% of hospitalizations and AKI-D occurred in 6.5%. AKI diagnosis increased from 44.0% in 2006 to 2007 to 61.7% in 2014 to 2015; AKI-D declined from 9.3% in 2006 to 2007 to 5.2% in 2014 to 2015. Mortality declined in all AKI categories but this varied by category: those with AKI-D had the smallest decline. Adjusted hospitalization costs were 19.1% higher in those with diagnosed AKI and 39.6% higher in those with AKI-D, compared to no AKI.

Limitations

Administrative data; timing of AKI with respect to VAD implantation cannot be determined; limited pre-existing chronic kidney disease ascertainment; discharge weights not derived for subpopulation of interest.

Conclusions

A decreasing proportion of patients undergoing VAD implantation experience AKI-D, but mortality among these patients remains high. AKI diagnosis with VAD implantation is increasing, possibly reflecting changes in AKI surveillance, awareness, and coding.

中文翻译：

---

放置心室辅助装置的急性肾脏损伤：趋势和结果的国家估计

理由与目标

心室辅助设备（VAD）用于不适合药物治疗的晚期心力衰竭。由于心力衰竭代偿，手术压力和其他因素，这种情况下的急性肾损伤（AKI）很常见。关于AKI诊断和需要透析的AKI（AKI-D）的全国趋势以及与VAD植入相关的结果知之甚少。我们调查了放置有植入式VAD的住院期间诊断AKI，AKI-D以及相关患者和资源利用结果的国家估计和趋势。

学习规划

对美国住院患者的20％分层样本进行的队列研究。

设置与参与者

2006年至2015年接受植入式VAD植入的患者。

接触

没有AKI诊断，没有透析的AKI，AKI-D。

结果

住院死亡率，住院时间，估计住院费用。

分析方法

使用调查设计方法进行分层，聚类和加权的多元逻辑和线性回归。

结果

估计放置了24140个可植入VAD，从2006年的853个增加到2015年的3945个。住院的AKI被诊断为56.1％，AKI-D的发生率为6.5％。AKI的诊断率从2006年至2007年的44.0％增加到2014年至2015年的61.7％; AKI-D的死亡率从2006年至2007年的9.3％下降至2014年至2015年的5.2％。所有AKI类别的死亡率均下降，但因类别而异：患有AKI-D的死亡率下降幅度最小。与没有AKI的患者相比，诊断为AKI的患者调整后的住院费用高出19.1％，而患有AKI-D的患者调整后的住院费用则高39.6％。

局限性

行政数据；关于VAD植入的AKI的时间无法确定；有限的预先存在的慢性肾脏疾病的确定；并非针对感兴趣的子群体得出的排放权重。

结论

接受VAD植入的患者中有AKI-D的比例下降，但这些患者的死亡率仍然很高。VAD植入对AKI的诊断正在增加，这可能反映了AKI监视，意识和编码方面的变化。