Saeed, Fahad; Adil, Malik M.; Vidal, Gabriel A.; Piracha, Bilal Hussain; Nahab, Fadi; Khan, Abdus Salam; Navaneethan, Sankar D.
Abstract
Background. In-hospital outcomes of transient ischemic attack (TIA) in patients with chronic kidney disease (CKD) and endstage renal disease (ESRD) requiring maintenance dialysis are largely unknown. We evaluated TIA-related in-hospital outcomes in these patients using a national database.; Methods. Our study is observational in nature. Data from all adult (>= 18 years) patients admitted to US hospitals between 2005 and 2011 with a primary discharge diagnosis of TIA and secondary diagnosis of CKD and ESRD were included using the Nationwide In-Patient Sample. We aimed to compare the following TIA-related outcomes between CKD and ESRD patients: (i) degree of disability (mainly functional status) derived from discharge destination, (ii) length of stay, (iii) charges of hospitalization, and (iv) mortality. The comparisons of TIArelated mortality and discharge outcomes between CKD and ESRD were analyzed after adjusting for potential confounders using logistic regression analysis. We adjusted for age, sex, comorbidities, hospital size and hospital teaching status.; Results. A total of 18 316 dialysis and 67 256 CKD patients were admitted with TIA in the study period (2005-11). On univariate analysis, there was no difference in the rates of moderate-to-severe disability (20.5% versus 20.2%, P = 0.7) and in-hospital mortality (0.4% versus 0.2%, P = 0.07) in ESRD patients compared with those with CKD. After adjusting for age, sex and potential confounders, ESRD patients with TIA had higher odds of moderate-to-severe disability at discharge [odds ratio (OR): 1.53, 95% confidence interval (CI): 1.37-1.71, P = 0.0001] and in hospital death (OR: 2.87, 95% CI: 1.29-6.37, P = 0.009).; Conclusion. ESRD patients with TIA have significantly higher rates of moderate-to-severe disability at discharge and inhospital mortality when compared with the patients of other stages of CKD who are not dialysis-dependent.
