Abstract Introduction Acute respiratory distress syndrome (ARDS) and kidney dysfunction frequently coexist through bidirectional lung-kidney interactions. ARDS and its supportive strategies (i.e. positive-pressure ventilation, fluid management, and vasoactive therapy) predispose patients to acute kidney injury (AKI), which can amplify systemic inflammation and multi-organ dysfunction, increasing morbidity and mortality. Tracheostomy is commonly performed in ARDS when prolonged mechanical ventilation or difficult weaning is anticipated. Appropriately selected patients may experience improved ventilator weaning, reduced sedation needs, and shorter ICU stays. Given the high prevalence of pulmonary-renal interactions, clinicians may hesitate to perform tracheostomy in ARDS patients with chronic kidney disease (CKD). To better inform clinical decision-making, we evaluated the association between CKD and inpatient mortality among patients with ARDS who underwent tracheostomy during their admission Methods We performed a retrospective cohort study using the National Inpatient Sample (NIS) from 2016-2020. Adult hospitalizations (≥18 years) were included if they had a diagnosis of ARDS (ICD-10: J80) and had procedure codes indicating they underwent either open (0B110F4) or percutaneous (0B113F4) tracheostomy. The control group consisted of patients without CKD (no N18 codes). Comparison groups included CKD of any stage (N18) and CKD stages 1 to end-stage renal disease or ESRD (N18.1-N18.6). Patients with unspecified CKD (N18.9) were excluded from stage-specific analyses due to the nonspecific nature of this code, though they were included in analyses with the aggregate N18 group. The primary outcome was in-hospital mortality. Mortality differences between groups were analyzed using Pearson’s chi-square tests. Results A total of 2,600 adult ARDS hospitalizations met inclusion criteria, including 2,176 without CKD and 424 with CKD. Overall mortality among patients with any CKD (N18) was 27.6%, compared with 21.5% among those without CKD (p = 0.88). Stage-specific mortality rates were 28.57% for stage 2, 24.17% for stage 3, 35.29% for stage 4, 20.00% for stage 5, and 31.25% for ESRD. There were no patients with CKD stage 1 to analyze. Across all CKD stages, no statistically significant difference in mortality was observed compared to the non-CKD group (all p 0.97). Conclusion In this large, nationally representative cohort of ARDS patients who underwent tracheostomy, the presence of CKD, including late stage CKD, was not associated with increased in-hospital mortality. These findings suggest that in ARDS, tracheostomy should not be withheld solely based on CKD status. Further studies evaluating long-term outcomes and renal function trajectories after tracheostomy may be warranted. This abstract is funded by: None
Zhou et al. (Fri,) studied this question.