C-41 | In-Hospital Outcomes of Revascularization for Coronary Artery Disease in Patients With Advanced Chronic Kidney Disease Versus End Stage Kidney Disease: National Inpatient Sample Database Analysis

Coronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with advanced chronic kidney disease (CKD) and End Stage Renal Disease (ESRD). While revascularization remains a pivotal therapy for CAD, current literature describing treatment outcomes in patients with comorbid advanced CKD and ESRD is limited. We sought to explore in-hospital outcomes and predictors of adverse outcomes among this population. A retrospective cohort study was conducted with data from the 2016 to 2020 combined National Inpatient Sample database. The outcomes of individuals with advanced chronic kidney disease (CKD5 and end-stage renal disease [ESRD]) undergoing coronary revascularization (via percutaneous coronary intervention or coronary artery bypass grafting) were analyzed using STATA version 18. A total of 586,730 patients underwent revascularization in the years 2016-2020. Of the 34,750 individuals with advanced CKD undergoing revascularization, logistic regression revealed increased odds of the following in persons with ESRD: mortality (OR 1.5, p < 0.001, *1.21-1.9), sepsis (1.86, p < 0.001, *1.47-2.35), mechanical ventilation (OR 1.22, p = 0.03, *1.02-1.46), vasopressor need (OR 1.57, p = 0.002, *1.19-2.08), post-operative bleeding (OR 1.99, p = 0.015, *1.14-3.47), and vascular complications (OR 1.41, p < 0.001, *1.18-1.68). Also noted was an increase in total hospital charge ($27,014, p < 0.001, *12,340-41,688) in the ESRD cohort.OR - odds ratio, *95% confidence interval. Revascularization in patients with CAD and comorbid ESRD had higher mortality, along with higher rates of complications compared to patients with comorbid advanced CKD.