BACKGROUND: There is a paucity of data regarding epidemiology, temporal trends, and outcomes of patients with cardiogenic shock (CS) and end-stage renal disease (chronic kidney disease stage V on hemodialysis). METHODS: This is a retrospective cohort study using the United States Renal Data System database from January 1, 2006 to December 31, 2019. We analyzed trends of CS, percutaneous mechanical support (intraaortic balloon pump, percutaneous ventricular assist device [Impella and Tandemheart], and extracorporeal membrane oxygenation) utilization, index mortality, 30-day mortality, and 1-year all-cause mortality in end-stage renal disease patients. RESULTS: A total of 43 825 end-stage renal disease patients were hospitalized with CS (median age, 67.8 years [IQR, 59.4–75.8] and 59.1% men). From 2006 to 2019, the incidence of CS increased from 275 to 578 per 100 000 patients ( P _trend <0.001). The index mortality rate declined from 54.1% in 2006 to 40.8% in 2019 ( P _trend =0.44), and the 1-year all-cause mortality decreased from 63% in 2006 to 61.8% in 2018 ( P _trend =0.73), but neither trend was statistically significant. There was a significantly decreased utilization of intra-aortic balloon pumps from 17 832 to 7992 ( P _trend <0.001), increased utilization of percutaneous ventricular assist device from 137 to 5201 ( P _trend <0.001) and increase in extracorporeal membrane oxygenation use from 69 to 904 per 100 000 patients ( P _trend <0.001). After adjusting for covariates, there was no significant difference in index mortality between CS patients requiring percutaneous mechanical support versus those not requiring percutaneous mechanical support (odds ratio, 0.97 [CI, 0.91–1.02]; P =0.22). On multivariable regression analysis, older age, peripheral vascular disease, diabetes, and time on dialysis were independent predictors of higher index mortality. CONCLUSIONS: The incidence of CS in end-stage renal disease patients has doubled without significant change in the trend of index mortality despite the use of percutaneous mechanical support.

Background: There is paucity of information on the incidence, clinical characteristics, admission trends, and outcomes of hypertensive crisis (HTN-C) in patients with end-stage kidney disease (ESKD) who are on maintenance dialysis. Methods: We conducted a retrospective observational study of HTN-C admissions in patients with end-stage kidney disease using the United States Renal Data System. We identified patients with end-stage kidney disease aged ≥18 years on dialysis and were hospitalized for HTN-C from January 2006 to August 2015. Results: A total of 54 483 patients with end-stage kidney disease were hospitalized for HTN-C during the study period. After study exclusions, 37 214 patients were included in the analysis. A majority of patients were Black, there were more women than men and the South region of the country accounted for a great majority of patients. During the study period, hospitalization rates increased from 1060 per 100 000 beneficiary years to 1821 ( P _trend <0.0001). Overall, in-hospital mortality, 30-day, and 1-year mortality were 0.6%, 2.3%, and 21.8%, respectively, and 30-day readmission rate was 31.1%. During the study period, most study outcomes showed a significant decreasing trend (in-hospital mortality 0.6%–0.5%, 30-day mortality 2.4%–1.9%, 1-year mortality 23.9%–19.7%, P _trend <0.0001 for all). Conclusions: Hospitalizations for HTN-C have increased consistently during the decade studied. Although temporal trends showed improving mortality and readmission rates, the absolute rates were still high with 1 in 3 patients readmitted within 30 days and 1 in 5 patients dying within 1 year of index hospitalization.

Summary: Background: Kidney transplantation (KT) has been shown to enhance the quality of life, be more cost-effective, and reduce mortality in dialysis patients. We aimed to study the impact of pre-existing diabetes mellitus (DM) and peripheral arterial disease (PAD) on cardiovascular outcomes and mortality after kidney transplantation (KT). Materials and methods: A secondary USRDS (United States Renal Data System) analysis was performed from 2006 to 2017 in adult patients who underwent KT. The primary outcome was 3-year all-cause mortality, and secondary outcomes were myocardial infarction (MI), cerebrovascular accident, gangrene/limb ischemia, and graft failure. Adjusted hazard ratios were computed, and multivariate analysis was conducted. All p-values were 2-sided, and a value of <0.05 was deemed to be statistically significant. Statistical analyses were performed using the SAS 9.4 software. Results: A total of 51,009 patients with kidney transplants met the study inclusion/ exclusion criterion. Patients with both DM and PAD had the highest risk of mortality (15.3%, aHR 1.8, 1.6–2.0), followed by patients with PAD without DM (14.1%, aHR 1.6, 1.4–1.9), DM without PAD (9.9%, aHR 1.4, 1.3–2.6), and those without either DM or PAD (5.5%). MI was also higher in patients with DM and PAD (7.3%, aHR 1.8, 1.5–2.2), followed by DM alone (4.6%, aHR 1.58, 1.4–1.7), PAD alone (4.3%, aHR 1.14, 0.8–1.6), and no diabetes nor PAD (2.2%). Conclusions: In patients undergoing KT, those with pre-existing DM and/ or PAD have a significantly higher all-cause mortality and risk of MI.

Objective To study the demographics, clinical presentations, and outcomes of emergency department (ED) visits of patients with heart transplantation (HT) in the United States. Methods We performed a secondary analysis of the National Emergency Department Sample database from 2016 to 2018. All ED visits of patients with HT aged >= 18 years were identified using International Classification of Diseases, Tenth Revision codes. Results Out of a total 308,182,495 national ED visits, 55,583 were HT-related visits. The median age was 61.07 years (interquartile range [IQR]: 46.91-69.38) and 69.44% were males. The hospital admission rate was 54.3% and median inpatient length of stay was 3.19 days (IQR: 1.63-5.92). The mortality rate during inpatient stay was 1.16%. Median inpatient and ED charges among admitted patients were $37,911 (IQR: $21,487-$71,262). The most common primary diagnosis of HT-related ED visits was sepsis (4.3%) followed by acute kidney injury (3.57%) and chest pain (3%). Conclusion More than half of total ED visits among HT patients resulted in hospital admission. The most common cause for ED visit in these patients was sepsis followed by acute kidney injury and chest pain.