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• W4365144670 abstract "Introduction Epidemiology and outcomes of cardiogenic shock (CS) in patients with end stage renal disease (ESRD) have not been well studied. The objective of this study is to analyze temporal trends of incidence and outcomes of cardiogenic shock and utilization of percutaneous left ventricular assist device (pLVAD) in patients with ESRD. Methods We identified all hospitalized patients with CS and ESRD between January 2006 to December 2018 utilizing the United States Renal Data System (USRDS) database. We analyzed trends in the incidence, use of mechanical circulatory support, in-hospital mortality, and 1-year all-cause mortality. Results There were a total of 38,679 patients with ESRD admitted for CS during the study period. Mean age was 67.8 years (IQR; 59.4, 75.9) and 59% were men. The annual incidence of CS in patients with ESRD increased from 0.27% to 0.57% from 2006 to 2018 (Ptrend<0.001) (Figure 1A). There was no significant change in in-hospital mortality (53.91% in 2006 and 41.41% in 2018; Ptrend =0.38) and 1-year all-cause mortality (28.91% in 2006 and 35.13% in 2017; Ptrend =0.1) during the study period (Figure 1B). There was decrease in the use of intra-aortic balloon pump from 17.86 % in 2006 to 8.25% in 2018 (Ptrend < 0.001) (Figure 1C) and a significant increasing trend in the use of Impella from 0.14% in 2006 to 4.8% in 2018 (Ptrend <0.001) (Figure 1D). On multivariable regression analysis, age, peripheral vascular disease (OR: 1.13, 95% CI: 1.08 to 1.18; p<0.0001), diabetes mellitus (OR: 1.11, 95% CI: 1.06 to 1.16; p<0.0001) and duration on dialysis are independent predictors of in-hospital mortality. The risk of CS increases with increasing duration on dialysis: time on dialysis 2-5 years (OR: 1.26, 95% CI: 1.20 to 1.32; p=0.02), 6-10 years (OR: 1.4, 95% CI: 1.32 to 1.5; p=0.003), and ≥11 years (OR: 1.69, 95% CI: 1.53 to 1.86; p<0.0001). Conclusion The incidence of CS in patients with ESRD has doubled between 2006 and 2018. There has been significant decrease in use of IABP with concomitant increase in utilization of Impella during this period but there was no significant change in in-hospital and 1-year all-cause mortality. Epidemiology and outcomes of cardiogenic shock (CS) in patients with end stage renal disease (ESRD) have not been well studied. The objective of this study is to analyze temporal trends of incidence and outcomes of cardiogenic shock and utilization of percutaneous left ventricular assist device (pLVAD) in patients with ESRD. We identified all hospitalized patients with CS and ESRD between January 2006 to December 2018 utilizing the United States Renal Data System (USRDS) database. We analyzed trends in the incidence, use of mechanical circulatory support, in-hospital mortality, and 1-year all-cause mortality. There were a total of 38,679 patients with ESRD admitted for CS during the study period. Mean age was 67.8 years (IQR; 59.4, 75.9) and 59% were men. The annual incidence of CS in patients with ESRD increased from 0.27% to 0.57% from 2006 to 2018 (Ptrend<0.001) (Figure 1A). There was no significant change in in-hospital mortality (53.91% in 2006 and 41.41% in 2018; Ptrend =0.38) and 1-year all-cause mortality (28.91% in 2006 and 35.13% in 2017; Ptrend =0.1) during the study period (Figure 1B). There was decrease in the use of intra-aortic balloon pump from 17.86 % in 2006 to 8.25% in 2018 (Ptrend < 0.001) (Figure 1C) and a significant increasing trend in the use of Impella from 0.14% in 2006 to 4.8% in 2018 (Ptrend <0.001) (Figure 1D). On multivariable regression analysis, age, peripheral vascular disease (OR: 1.13, 95% CI: 1.08 to 1.18; p<0.0001), diabetes mellitus (OR: 1.11, 95% CI: 1.06 to 1.16; p<0.0001) and duration on dialysis are independent predictors of in-hospital mortality. The risk of CS increases with increasing duration on dialysis: time on dialysis 2-5 years (OR: 1.26, 95% CI: 1.20 to 1.32; p=0.02), 6-10 years (OR: 1.4, 95% CI: 1.32 to 1.5; p=0.003), and ≥11 years (OR: 1.69, 95% CI: 1.53 to 1.86; p<0.0001). The incidence of CS in patients with ESRD has doubled between 2006 and 2018. There has been significant decrease in use of IABP with concomitant increase in utilization of Impella during this period but there was no significant change in in-hospital and 1-year all-cause mortality." @default.
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• W4365144670 date "2023-04-01" @default.
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• W4365144670 title "Trends Of Cardiogenic Shock And Percutaneous Left Ventricular Assist Device Utilization In Patients With ESRD" @default.
• W4365144670 doi "https://doi.org/10.1016/j.cardfail.2022.10.099" @default.
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