National Data Show Rising Risk, Cost of CKD in Patients With Acute Myocardial Infarction

Emerging research featured at the National Kidney Foundation Spring Clinical Meeting suggests that the impact of chronic kidney disease (CKD) varies when patients are being treated with cardiac interventions. CKD is a well-established risk factor for poor outcomes in patients with cardiovascular disease (CVD), but in cases of CVD-related hospitalizations, research is limited. Using data from the 2016-2020 Nationwide Readmissions Database, investigators conducted several studies that have shed new light on how both early and advanced CKD—as well as end-stage renal disease (ESRD)—affect outcomes and resource utilization in patients hospitalized for acute myocardial infarction (AMI).

These studies demonstrate the clinical and economic impact that CKD has on hospitalization.

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MCS in Advanced CKD: Increased Mortality, Bleeding, Resource Use

Among patients with AMI treated with temporary mechanical circulatory support (MCS), advanced CKD was associated with higher odds of fatal and non-fatal adverse outcomes and higher resource utilization compared with patients without advanced CKD.¹ Advanced CKD was also associated with higher resource utilization.

Using data from the 2016-2020 Nationwide Readmission Database, the researchers investigated outcomes among patients with AMI who received MCS, focusing on those with advanced CKD stages 4 and 5. The study included 80,194 patients with AMI receiving temporary MCS and found that 3.1% of these patients had advanced CKD.

The primary outcome assessed was inpatient mortality, with secondary outcomes including all-cause 90-day readmissions, major bleeding events, acute kidney injury (AKI), length of stay, and total charges. After adjusting for confounding factors using multivariate linear and logistic regression models, the researchers observed significant associations between advanced CKD and adverse outcomes.

Those with advanced CKD had higher odds of inpatient mortality compared with those without advanced CKD (adjusted OR [aOR] 1.18; 95% CI, 1.04–1.34). Additionally, they were more likely to experience AKI (aOR 4.7; 95% CI, 3.8–5.8), major bleeding events (aOR 1.15; 95% CI, 1.01–1.3), longer hospital stays (16.4 vs 12.8 days), and incurred higher total charges ($416,011 vs $373,266) than patients without advanced CKD. However, there were no significant differences in all-cause 90-day readmissions between the groups (aOR 0.75; 95% CI, 0.29–1.9).

CABG Outcomes After AMI: Greater Risk, Expense in ESRD vs CKD

The next study found that ESRD is associated with significantly worse outcomes compared with advanced CKD (stages 4-5) among patients undergoing coronary artery bypass grafting (CABG) following AMI.² The study, which examined data from the 2016-2020 Nationwide Readmissions Database, sheds light on the heightened clinical and economic burden carried by patients with ESRD in the context of cardiac surgery.

Researchers identified 34,327 patients with AMI who underwent CABG, of whom 15.3% had ESRD and 10% had advanced CKD. Patients with ESRD were more likely to be in lower income brackets and enrolled in Medicaid. When comparing outcomes, ESRD was independently associated with higher inpatient mortality (aOR, 1.5; 95% CI, 1.12–2.02), increased use of mechanical ventilation (aOR, 1.31; 95% CI, 1.03–1.66), longer hospital stays (26.8 vs 20.6 days), and substantially higher total hospitalization charges ($681,996 vs $498,020), all of which reached statistical significance (P < .001).

Despite these differences, no significant variations were observed between ESRD and advanced CKD patient groups in the rates of major bleeding, MCS use, stroke, or all-cause 90-day readmissions. These findings indicate that while both kidney disease populations face elevated risks, ESRD patients, in particular, experience greater severity of illness and resource use during hospitalization for CABG after AMI.

Early-Stage CKD Associated With Greater Health Care Utilization After PCI

Analyzing the same data from the 2016-2020 Nationwide Readmissions Database, the third investigation found that even early-stage CKD may impact recovery and health care resource use among patients undergoing multivessel percutaneous coronary intervention (PCI) for AMI.³ While early-stage CKD (stages 1-2) was not linked to an increase in inpatient mortality, it was associated with greater odds of readmission and higher health care costs.

The study included 22,571 patients hospitalized for AMI who underwent multivessel PCI, of whom 1.6% had early-stage CKD. After adjusting for confounding factors, researchers found that early-stage CKD was not significantly associated with higher odds of inpatient mortality (aOR, 0.69; 95% CI, 0.46–1.04). However, patients with early-stage CKD experienced significantly higher odds of all-cause 90-day readmissions (aOR 1.92, 95% CI 1.1–3.4), stayed in the hospital longer (12.2 vs 11.1 days), and incurred greater hospitalization charges ($351,599 vs $325,666).

There were no statistically significant differences between patients with and without early-stage CKD in terms of acute kidney injury (aOR, 1.3; 95% CI, 0.90–1.9) or major bleeding events (aOR, 0.89; 95% CI, 0.63–1.3). These findings suggest that although early-stage CKD does not increase the risk of mortality or major complications during hospitalization, it may contribute to more complex recoveries and greater overall use of health care resources.

CKD Impacts Recovery, Costs in AMI Interventions

Taken together, these studies reinforce the clinical and economic burden that varying stages of CKD place on patients undergoing treatment for AMI. While advanced CKD and ESRD are clearly associated with higher mortality and complication rates, even early-stage CKD can increase the likelihood of hospital readmission and drive up costs despite not affecting in-hospital mortality. The consistent association between impaired kidney function and prolonged hospital stays, higher charges, and greater resource utilization across interventions underscores the need for more proactive, stage-specific management strategies.

References

1. Abdallah N, Aladeaileh A. Associations between advanced chronic kidney disease and outcomes in patients with acute myocardial infarction receiving temporary mechanical circulatory support: a nationwide analysis from the United States. Presented at: National Kidney Foundation Spring Clinical Meeting (SCM25). April 9-13, 2025. Boston, MA. Session G-290

2. Abdallah N, Aladeaileh A. Hospitalization and Readmission Outcomes in Acute Myocardial Infarction Patients Undergoing Coronary Artery Bypass Grafting: Comparing Advanced Chronic Kidney Disease and End-Stage Renal Disease. Presented at: National Kidney Foundation Spring Clinical Meeting (SCM25). April 9-13, 2025. Boston, MA. Session G-291.

3. Abdallah N, Aladeaileh A. Associations between Early-Stage Chronic Kidney Disease and Outcomes in Patients with Acute Myocardial Infarction Undergoing Multivessel Percutaneous Coronary Intervention: A Nationwide Analysis from the United States. Presented at: National Kidney Foundation Spring Clinical Meeting (SCM25). April 9-13, 2025. Boston, MA. Session G-289.