{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:39:35Z","timestamp":1786729175512,"version":"build-2736575974"},"reference-count":23,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"2","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with more infections, prolonged recovery, longer hospital stays, increased readmission rates, greater costs, and higher mortality. Patients with pre-existing chronic kidney disease (CKD) are at particularly high risk, with this risk increasing as renal function worsens. Damage caused by AKI may be irreversible, despite a return to baseline GFR, compounding stress on remaining nephrons. Understanding risk in these populations may ultimately help to improve prevention and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Evaluate the impact of AKI on outcomes and healthcare costs among adults with CKD undergoing cardiac surgery with cardiopulmonary bypass (CPB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multi-institutional, retrospective, observational study using the Healthcare Cost and Utilization Project Nationwide Readmissions Database, 2016-2020 datasets. The total adult cardiac surgery population were those with CKD who underwent cardiac surgery requiring CPB (reporting incidence); from which a subpopulation of adults with severe CKD (stage 3 or 4; based on ICD-10-CM codes during index hospitalization) was assessed (impact of AKI). Patients were categorized as follows, based on AKI status during index hospitalization: no AKI, AKI, or AKI requiring dialysis (a subpopulation of AKI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AKI incidence during initial hospitalization was 55.9% and 77.3% in patients with CKD stage 3 and 4, respectively. AKI requiring dialysis occurred in 3.4% and 14.5% of CKD 3 and 4 patients, respectively. One-third of all AKI cases and half of AKI requiring dialysis cases occurred in patients with CKD stage 3 or 4. In patients with CKD stage 3 or 4, multivariate analysis showed AKI was associated with increased inpatient days, increased risk of 180-day readmission, higher hospitalization costs, and greater odds of in-hospital mortality. Patients experienced the greatest burden when AKI required dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Incidence of AKI is higher in patients with preexisting CKD stage 3 or 4 vs 1 or 2 and those without CKD. The burden of AKI is elevated in patients with CKD undergoing cardiac surgery with CPB; targeted interventions are needed to prevent poor outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.36469\/001c.163558","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:52:41Z","timestamp":1786726361000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Acute Kidney Injury on Hospitalization Outcomes in Patients with Chronic Kidney Disease Undergoing Cardiac Procedures with Cardiopulmonary Bypass in the United States"],"prefix":"10.36469","volume":"13","author":[{"given":"Nicolas","family":"Pope","sequence":"first","affiliation":[{"name":"Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby","family":"Greenblatt","sequence":"additional","affiliation":[{"name":"Real World Data & Analytics, RTI Health Solutions, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thain\u00e1","family":"Jeh\u00e1","sequence":"additional","affiliation":[{"name":"Alexion, AstraZeneca Rare Disease, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Meyers","sequence":"additional","affiliation":[{"name":"Real World Data & Analytics, RTI Health Solutions, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Solinsky","sequence":"additional","affiliation":[{"name":"Alexion, AstraZeneca Rare Disease, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh C.","family":"Arora","sequence":"additional","affiliation":[{"name":"Harrington Heart & Vascular Institute, University Hospitals, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Alexion, AstraZeneca Rare Disease, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1038\/ki.2008.107","article-title":"The risk of acute renal failure in patients with chronic kidney disease","volume":"74","author":"C. 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