Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: a population-based study

Abstract

Background: Little is known about the relationship between acute kidney injury (AKI) and outcomes after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to investigate associations between AKI and readmission risks after hospitalization for AECOPD.

Methods: A retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. We identified all adults (aged ≥40 years) hospitalized for AECOPD during the study period. Among them, we further identified patients with a concurrent diagnosis of new AKI. The outcome measures were any-cause readmissions within 30 days and 90 days after hospitalization for AECOPD. To determine associations between AKI and readmission risk, we constructed Cox proportional hazards models examining the time-to-readmission. We also identified the primary reason of readmission.

Results: We identified 356,990 patients hospitalized for AECOPD. The median age was 71 years and 41.9% were male. Of these, 24,833 (7.0%) had a concurrent diagnosis of AKI. Overall, patients with AKI had significantly higher risk of 30-day all-cause readmission compared to those without AKI (hazard ratio 1.47; 95% CI 1.43-1.51; P < 0.001). Likewise, patients with AKI had significantly higher risk of 90-day all-cause readmission (hazard ratio 1.35; 95% CI 1.32-1.38; P < 0.001). These associations remained significant after adjustment for confounders (both P < 0.05). Additionally, patients with AKI were likely to be readmitted for non-respiratory reasons including sepsis, acute renal failure, and congestive heart failure.

Conclusions: Among patients hospitalized for AECOPD, patients with AKI were at higher risk of 30-day and 90-day readmission, particularly with non-respiratory reasons.

Keywords: Acute exacerbation of COPD; Acute kidney injury; Population-based study; Readmission.

Fig. 1

Kaplan-Meier survival estimates of all-cause readmission risk during 30-day period after the index hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Patients with acute kidney injury (AKI) had a significantly higher risk of all-cause readmission during 30-day period after the index hospitalization, compared to those without AKI (P_log-rank < 0.001)

Fig. 2

Kaplan-Meier survival estimates of all-cause readmission risk during 90-day period after the index hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Patients with acute kidney injury (AKI) had a significantly higher risk of all-cause readmission during 90-day period after the index hospitalization, compared to those without AKI (P_log-rank < 0.001)