P0625 - Temporal Trend and Predictors of Acute Kidney Injury in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

Tsujung Yang, MD¹, Shriya Goyal, MD², Ntasha Roy, MD, MHA³, Muhammad Siddiqui, MD⁴, Salma Habib, MD⁵, Lutfor Nessa, MD, MPH⁶, Subash Ghimire, MD⁷, Ruchir Goswami, MBBS, MPH⁸, Hardikkumar Shah, MD, MPH⁹, Achint Patel, MD, MPH¹⁰, Matthew Grossman, MD^9
1MultiCare Good Samaritan Hospital, Puyallup, WA; ²Mayo Clinic, Rochester, MN; ³University of Southern California, Los Angeles, CA; ⁴University of Medicine and Health Sciences, Coram, NY; ⁵Institute of Applied Health Science, Brooklyn, NY; ⁶University of North Texas Health Science Center, Fort Worth, TX; ⁷Guthrie Robert Packer Hospital, Sayre, PA; ⁸Icahn School of Medicine at Mount Sinai, New York, NY; ⁹St. Joseph's University Medical Center, Paterson, NJ; ¹⁰Icahn School of Medicine at Mount Sinai, Rochester, NY

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a safe and minimally invasive procedure that is used for both therapeutic and diagnostic intervention for pancreatic-biliary diseases. During the procedure, water-soluble iodine-based contrast media is injected into the biliary and pancreatic ducts which may be absorbed into the bloodstream triggering an increasing risk of Acute Kidney Injury (AKI). However, there are very few studies to show this trend. The aim of this study is to evaluate the incidence of post-ERCP AKI, identify predictors and impact of AKI among patients undergoing ERCP from a nationally representative database.

Methods: We identified adult hospitalizations undergoing ERCP by using International Classification of Diseases (9th/10th Editions) Clinical Modification (ICD-9-CM/ICD-10-CM) from the Nationwide Inpatient Sample (NIS) for the years 2007-2018. AKI was identified by using previously validated codes and comorbidities by Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends and predictors of AKI on ERCP outcomes.

Results: Out of a total 1,942,313 ERCP procedures from 2007-2018, 223,063 (11.48%) were completed by AKI. Incidence of post-ERCP AKI increased from 6.4% in 2007 to 16.4% in 2018. Even after adjusting with demographics and comorbidities, there was unexplained yearly increase of 6% in incidence of AKI (OR 1.06; 95%CI 1.05-1.06; p < 0.01). Patients who developed AKI were older, male and African American. In multivariable regression analysis, age (OR 1.3; 95% CI 1.3-1.3; p < 0.01), males (OR 1.0; 95%CI 1.6-1.7; p < 0.01), African American (OR 1.6; 95% CI 1.6 -1.7, p < 0.01), septicemia (OR 4.2; 95% CI 4.1-4.3, p < 0.01), CHF (OR 2.2; 95% CI 2.1-2.2, p < 0.01), hypertension (OR 1.4; 95% CI 1.3-1.4, p < 0.01), diabetes mellitus (OR 1.1 ;95% CI 1.1-1.1, p = 0.039), cirrhosis (OR 1.7; 95% CI 1.6-1.8, p < 0.01) and acute pancreatitis (OR 1.2; 95% CI 1.1-1.2, p < 0.01), obesity (OR 1.4; 95% CI 1.3- 1.4, p < 0.01) were associated with higher odds of post-ERCP AKI.

Discussion: In this nationally representative study, we observed an unexplained increase of AKI following ERCP over the last decade. We were also able to delineate several factors which were significantly associated with the development of AKI. Our study highlights the need for better risk stratification and preventive strategies among vulnerable patients undergoing ERCP.


Disclosures:


Tsujung Yang, MD¹, Shriya Goyal, MD², Ntasha Roy, MD, MHA³, Muhammad Siddiqui, MD⁴, Salma Habib, MD⁵, Lutfor Nessa, MD, MPH⁶, Subash Ghimire, MD⁷, Ruchir Goswami, MBBS, MPH⁸, Hardikkumar Shah, MD, MPH⁹, Achint Patel, MD, MPH¹⁰, Matthew Grossman, MD⁹. P0625 - Temporal Trend and Predictors of Acute Kidney Injury in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.