Background: Patients with end-stage renal disease (ESRD) undergoing left heart catheterization (LHC) represent a high-risk population due to significant comorbidity burden and accelerated cardiovascular disease. Contemporary national data evaluating in-hospital outcomes in this population remain limited. Methods: We conducted a retrospective cohort study using the 2022 National Inpatient Sample (NIS). Adult hospitalizations (≥18 years) with ESRD who underwent LHC were identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, length of stay, total hospital charges, and use of mechanical circulatory support. Multivariable logistic regression was performed to identify independent predictors of mortality, adjusting for patient demographics, comorbidities, hospital characteristics, and procedure type. Survey weighting was applied to generate national estimates. Results: A total of 3,756 unweighted hospitalizations met the inclusion criteria, corresponding to 18,780 weighted national hospitalizations. The overall in-hospital mortality rate was 4.2% (158 of 3,756 unweighted (4.2%); 790 of 18,780 weighted (4.2%)). Patients undergoing therapeutic LHC had higher mortality compared to diagnostic procedures (5.1% (96 of 1,882 unweighted) vs. 3.4% (62 of 1,874 unweighted), p = 0.02). On multivariable analysis, cardiogenic shock (adjusted odds ratio (aOR) 5.90, 95% confidence interval (CI) 4.10-8.50), advanced age (aOR 1.03 per year, 95% CI 1.02-1.04), and coagulopathy (aOR 1.80, 95% CI 1.20-2.04) were independently associated with increased mortality. Female sex was associated with lower mortality (aOR 0.78, 95% CI 0.60-0.99). Conclusions: Among ESRD patients undergoing LHC in the United States, in-hospital mortality remains substantial, particularly in those undergoing therapeutic interventions and those presenting with cardiogenic shock. These findings underscore the importance of careful risk stratification in this vulnerable population.
Teddy et al. (Sun,) studied this question.