Pepingco, Christianna

Silverstein Fadlon, Cheri, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationThe Association of End-Stage Renal Disease andThoracic Aortic Aneurysm in the NationalInpatient SampleChristianna PepingcoCheri Silverstein Fadlon MDLehigh Valley Health Network, Cheri.SilversteinFadlon@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtPepingco, C., Silverstein-Fadlon, C., (2018, 3, August) The Association of End-Stage Renal Disease and Thoracic Aortic Aneurysm in theNational Inpatient Sample. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network,Allentown, PA.Lehigh Valley Health Network, Allentown, Pennsylvania• The normal size of the thoracic aorta is influenced by age,sex, and BSA. Dilation beyond the aorta’s normal limits canlead to a thoracic aortic aneurysm (TAA) or dissection if leftuntreated. [1]• Cardiovascular disease (CVD) is one of the main causes ofmortality and morbidity in end-stage renal disease (ESRD)patients. [3]• Sparse literature exists about the prevalence and relationshipbetween TAA in ESRD patients.• A 2015 pediatric study found that aortic dilation is associatedamong children with glomerular ESRD and low BMI z-scores.[4]• The National Inpatient Sample(NIS) is the largest inpatientdatabase in the U.S. and is usedin this study to provide insightof the association of ESRD andTAA.References1. Hiratzka, L. F., Bakris, G. L., Beckman, J. A., Bersin, R. M., Carr, V. F., Casey, D. E., . . . Williams, D. M. (2010). 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for theDiagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on PracticeGuidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society forCardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation,121(13).doi:10.1161/cir.0b013e3181d4739e2. Ascending aortic aneurysm icon. (n.d.). Retrieved from https://www.123rf.com/photo_96683368_stock-vector-ascending-aortic-aneurysm-icon.html3. Levin, A. (2008). THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Clinical Epidemiology of Cardiovascular Disease in Chronic KidneyDisease Prior to Dialysis. Seminars in Dialysis,16(2), 101-105. doi:10.1046/j.1525-139x.2003.16025.x4. Kaddourah, A., Uthup, S., Madueme, P., O’Rourke, M., Hooper, D. K., Taylor, M. D., … Goebel, J. (2015). Prevalence and predictors of aortic dilation as a novel cardiovascularcomplication in children with end-stage renal disease . Clinical Nephrology, 83(5), 262–271. http://doi.org/10.5414/CN1084895.5. Prakash SK, Pedroza C, Khalil YA, Milewicz DM. Diabetes and Reduced Risk for Thoracic Aortic Aneurysms and Dissections: A Nationwide Case-Control Study. Journal of the AmericanHeart Association: Cardiovascular and Cerebrovascular Disease. 2012;1(2):jah3-e000323. doi:10.1161/JAHA.111.000323.1•Utilized SPSS to randomly sample 25% of cases in NIS Database from 2003 to 20142•Categorized patients based on diagnoses with TAA, ESRD, and other clinical factors3•Performed a chi-square test of independence and both univariate and multivariate logistic regression analysis on selected variates4•Compared with previous studies to support or refute findingsBACKGROUNDMETHODSRESULTS CONCLUSIONSLIMITATIONS AND FUTURE WORKThe Association of End-Stage Renal Disease and Thoracic Aortic Aneurysm in the National Inpatient SampleChristianna Pepingco and Cheri Silverstein Fadlon, MDDivision of Cardiology• To analyze the relationship between ESRD and TAA inpatients ages 18 and above in the NIS• To identify risk factors of TAA in our population andevaluate whether they align with existing literatureOBJECTIVESTable 1. Odds Ratio and 95% CI for Selected Variables.Figure 1. Normal aorta vs ascending aortic aneurysm [2]• With a p-value of less than 0.001 and a chi-squaredstatistic of 61,813.914 from the chi-squared testanalysis, a statistically significant relationship existsbetween ESRD and TAA.• ESRD is a significant predictor in univariate (OR: 5.592,CI: 5.507-5.678) and multivariate (OR: 8.013, CI: 7.875-8.153) analyses for the development of TAA.• Since 86.8% of patients with ESRD and TAA and 21.8%of all cases with TAA also had a thoracic aorticdissection, the NIS is predominantly capturing TAA thatis associated with acute thoracic disease.– Analysis not representative of prevalence of andrisk factors for chronic stable thoracic aorticdisease• Hypertension is a strong predictor in univariate and notin multivariate analysis. ESRD may be capturing bulk ofrisk associated with long standing poorly controlledhypertension• Diabetes is a negative predictor of TAA, which alignswith literature [5].Figure 2. Process for categorizing variables for chi-squared test of Independence. Patients with AKI are excluded from dialysis patients as they would temporarily be on dialysis without record of CKD or ESRD.0.8% of ESRD patients have thoracic aortic aneurysm as compared to 0.15% of other patients.  The X2statistic is 61,813.914 and p-value is < 0.001.12.4%2.5%02468101214Frequencies of ESRDFrequencies of ESRD in Patients with and without TAATAANo TAAFigure 3. The frequency of ESRD in patients with TAA is greater than the frequency of ESRD in patients with TAA, which indicates that the two conditions may have an association. Limitations of NIS• Does not include variables like height, weight, and BSA• Reliance on ICD-9 code.  No records of laboratories or imaging to verify TAA + or -• Selection of cases biased toward acute disease.  May lead to misclassification of controls• Cross-sectional data only Recommendations• Run a correlation test on the variates • Compare difference between ESRD patients on hemodialysis and peritoneal, those on dialysis and those with kidney transplant, and glomerular ESRD and non-glomerular ESRD to better clarify mechanism• Add socio-economic data as a variable Future Work• Use United States Renal Data System data to evaluate prevalence of chronic stable thoracic aortic disease in patients with ESRD• Use LVHN data to conduct a study of ESRD as a risk factor for thoracic aortic disease with ability to more precisely classify patients with ESRD and thoracic aortic aneurysm

The Association of End-Stage Renal Disease and Thoracic Aortic Aneurysm in the National Inpatient Sample

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The Association of End-Stage Renal Disease and Thoracic Aortic Aneurysm in the National Inpatient Sample

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