Characteristics and Outcomes of Patients with Cardiogenic Shock Complicated by Acute Kidney Injury Requiring Hemodialysis

Purpose In the setting of Cardiogenic Shock (CS), impaired biventricular function can lead to an acute decrease in renal function via reduced renal perfusion and increased renal venous pressure. In a nationally representative sample, we sought to analyze the characteristics and outcomes of patients hospitalized with CS requiring renal replacement therapy (hemodialysis) for acute kidney injury (AKI-HD). Methods We utilized data from the National Inpatient Sample to calculate national rates of in-hospital mortality, use of temporary mechanical support (T-MCS), vascular injury requiring surgery (VI), length of stay (LOS) and hospitalization cost from 2010 to 2015. We compared the in-hospital outcomes between CS with AKI-HD and a propensity score-matched group without AKI-HD Results We identified 6,076 patients (weighted n=29,921) with CS and AKI-HD and 81,865 (weighted n=403,081) with CS not AKI-HD. Patients with CS and AKI-HD were more likely to have diabetes mellitus [40.3% vs. 34.5%, standardized difference (SD) 0.12], pre-existing chronic kidney disease (48.8% vs. 28.2%, SD 0.4) and higher comorbidity burden as assessed by Elixhauser score (score ≥4 in 74.6% vs. 50.6%) compared with CS patients without AKI-HD. After matching 5,513 cases for patient-level and hospital-level characteristics, CS with AKI-HD was associated with significantly higher in-hospital mortality (73.1% vs. 53.5%, p Conclusion AKI-HD occurred in approximately 7% of patients with CS in years 2010-2015 and was associated with significantly increased in-hospital morbidity and mortality, LOS and cost.