• Ashish Correa, Achint Patel, Kinsuk Chauhan, Harshil Shah, Aparna Saha, Mihir Dave, Priti Poojary, Abhishek Mishra, Narender Annapureddy, Shaman Dalal, Ioannis Konstantinidis, Renu Nimma, Shiv Kumar Agarwal, Lili Chan, Girish Nadkarni, and Sean Pinney.
• Department of Medicine, Mount Sinai St. Luke's-West Hospital/Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: ashish.correa@mountsinai.org.
• J. Card. Fail. 2018 Jul 1; 24 (7): 442-450.

BackgroundDialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.MethodsWe used the Nationwide Inpatient Sample (2002-2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS), and cost. We calculated adjusted odds ratios (aORs) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).ResultsWe identified 11,205,743 HF hospitalizations. Across 2002-2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male sex, younger age, African-American and Hispanic race, and various comorbidities and procedures, such as sepsis and mechanical ventilation, to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR 2.49, 95% confidence interval [CI] 2.36-2.63; P < .01) and adverse discharge (aOR 2.04, 95% CI 1.95-2.13; P < .01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002-2013. LoS and cost also decreased across this period.ConclusionsThe incidence of D-AKI in HF hospitalizations doubled across 2002-2013. Despite declining in-hospital mortality, LoS, and cost, D-AKI was associated with worse outcomes.Copyright © 2018 Elsevier Inc. All rights reserved.

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