Research on ESRD and PCI Outcomes

New research has revealed that end-stage renal disease (ESRD) patients undergoing percutaneous coronary intervention (PCI) have considerably higher in-hospital outcomes like mortality, cost, and length of stay than those not having end-stage renal disease. The study results were published in the journal Cardiovascular Revascularization Medicine.

When the kidneys can no longer carry out their normal function, a person has end-stage renal disease and needs renal replacement treatment or a kidney transplant. The major cause of mortality for those with ESRD is cardiovascular disease due to increased coronary plaque and calcifications leading to a hyper-inflammatory state. Previous literature has shown that ESRD patients undergoing PCI have an increase in in-hospital mortality and prolonged hospitalization, among other complications when compared with non-ESRD patients undergoing the same procedure. Hence researchers conducted a study to evaluate the in-hospital mortality after PCI in the setting of Acute Coronary Syndrome (ACS) using the National Inpatient Database (NIS) between the years 2016–2019 in ESRD patients.

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Patients who had PCI between 2016 and 2019 were identified using the national inpatient sample (NIS). Patients with ESRD receiving renal replacement therapy (RRT) were then put into separate groups. In-hospital mortality was evaluated using logistic regression models as the primary outcome, while hospitalization costs and duration of stay were evaluated using linear regression models as the secondary outcomes.

Key Findings:

• Nearly 21,366 unweighted observations were initially included, which had 50% ESRD patients and 50% randomly selected patients without ESRD who underwent PCI.
• A nationwide estimate of 106,830 patients was represented by these weighted observations.
• The mean age of the study population was 65 years, and 63% of the patients were male.
• The ESRD group had a greater representation of minority groups compared to the control group.
• ESRD group showed a significantly higher in-hospital mortality rate when compared to the control group, with an odds ratio of 1.803.
• The ESRD group also had a significantly higher healthcare cost and longer length of stay, with a mean difference of $47,618 and 2.933 days.

Thus, the in-hospital mortality, cost, and length of hospital stay for patients undergoing PCI in the setting of ACS were found to be significantly greater in the ESRD group.

Further reading: In-hospital outcomes of PCI in patients who have ESRD vs non-ESRD patients, a retrospective study involving a National Inpatient Sample (NIS) database.