Hospitalizations With Pericarditis and Pericardial Effusions in People With Kidney Failure Receiving Dialysis in the United States (2016-2021).

RATIONALE &

OBJECTIVE

Pericarditis and pericardial effusions may complicate the clinical course of people with kidney failure receiving dialysis. However, few recent data exist on their incidence or associated outcomes and costs. This study characterized hospitalizations among a nationally representative set of US patients receiving maintenance dialysis who experienced pericarditis or pericardial effusion.

STUDY

DESIGN

Retrospective cohort study.

SETTING &

PARTICIPANTS

Adults with dialysis-dependent kidney failure, represented in the National Inpatient Sample (NIS) (2016-2021), a database of ∼20% of nonfederal acute care hospitalizations in the United States, with pericarditis or pericardial effusions identified using administrative codes.

EXPOSURE: Calendar year, pericardial drainage procedures, and cardiac tamponade or cardiogenic shock.

OUTCOME: Trends in in-hospital mortality, costs, and repeat pericardial drainage procedures.

ANALYTICAL APPROACH: Survey methods with weighted least squares regression to characterize trends. Logistic regression for the risk of repeat pericardial drainage. In-hospital mortality was characterized as a proportion of hospital stays. Cost estimation was based on hospitalization charges and cost-to-charge ratios.

RESULTS

We identified 18,535 hospitalizations in the NIS sample, representing a total of 92,675 (95% CI, 90,674-94,676) nonfederal acute care hospital stays. The mean age was 57 years, and 49% were female. Pericardial tamponade or shock was diagnosed in 11.1% (95% CI, 10.6-11.6) of hospitalizations, pericardial drainage procedures were performed in 13.1% (95% CI, 12.6-13.6%), and in-hospital mortality was 7.8% (95% CI, 7.4-8.2%). The counts of hospitalizations increased by an average of 1,370 (95% CI, 1,108-1,631; P < 0.001) per year and percutaneous drainage procedures by an average of 131 (95% CI, 15-246; P = 0.04) per year. The rate of hospitalization increased from 2.3 (95% CI, 2.2-2.4) per 100 person-years in 2016 to 3.5 (95% CI, 3.4-3.7) in 2021 (P for trend = 0.001). Hospital costs increased from $347 million (95% CI, $316-378 million) in 2016 to $591 million (95% CI, $545-637 million) in 2021 (P = 0.001).

LIMITATIONS: Administrative data.

CONCLUSIONS

Hospitalizations for pericarditis or pericardial effusion among patients on dialysis have increased in recent years, with a corresponding increase in pericardial drainage procedures. More than 1 in 10 hospitalizations were complicated by tamponade or shock. Identifying actionable drivers of the increase in this morbidity over time warrants further investigation.

PLAIN-LANGUAGE SUMMARY: Inflammation of the connective tissue lining the heart (pericarditis) and accumulation of fluid around the heart (pericardial effusion) can occur in people who receive dialysis for kidney failure. However, little is known about how often this occurs in recent years or the related outcomes and costs. This study estimated how often hospitalizations with pericarditis or pericardial effusion in people with kidney failure on dialysis occur in the United States. We found that the number of hospitalizations with these problems and procedures to treat them have increased from 2016 to 2021. Additionally, the total cost of these hospitalizations increased from 2016 to 2021. The reasons for the observed increases are uncertain and warrant further study.