Contemporary trend of acute kidney injury incidence and incremental costs among US patients undergoing percutaneous coronary procedures.

OBJECTIVES: To assess national trends of acute kidney injury (AKI) incidence, incremental costs, risk factors, and readmissions among patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) during 2012-2017. BACKGROUND: AKI remains a serious complication for patients undergoing CAG/PCI. Evidence is lacking in contemporary AKI trends and its impact on hospital resource utilization. METHODS: Patients who underwent CAG/PCI procedures in 749 hospitals were identified from Premier Healthcare Database. AKI was defined by ICD-9/10 diagnosis codes (584.9/N17.9, 583.89/N14.1, 583.9/N05.9, E947.8/T50.8X5) during 7 days post index procedure. Multivariable regression models were used to adjust for confounders. RESULTS: Among 2,763,681 patients, AKI incidence increased from 6.0 to 8.4% or 14% per year in overall patients; from 18.0 to 28.4% in those with chronic kidney disease (CKD) and from 2.4 to 4.2% in those without CKD (all p < .001). Significant risk factors for AKI included older age, being uninsured, inpatient procedures, CKD, anemia, and diabetes (all p < .001). AKI was associated with higher 30-day in-hospital mortality (ORadjusted = 2.55; 95% CI: 2.40, 2.70) and readmission risk (ORadjusted = 1.52; 95% CI: 1.50, 1.55). The AKI-related incremental cost during index visit and 30-day readmissions were estimated to be $8,416 and $580 per inpatient procedure and $927 and $6,145 per outpatient procedure. Overall excess healthcare burden associated with AKI was $1.67 billion. CONCLUSIONS: AKI incidence increased significantly in this large, multifacility sample of patients undergoing CAG/PCI procedures and was associated with substantial increase in hospital costs, readmissions, and mortality. Efforts to reduce AKI risk in US healthcare system are warranted.

Use of the artificial iris implant in patients with aniridia.

BACKGROUND: Aniridia (or partial aniridia) often occurs as a result of a penetrating ocular trauma. This condition may cause symptoms including glare, light sensitivity, reduced vision, and asymmetric appearance. Options for these patients include specialty contact lenses, corneal tattooing, and artificial iris implants. This article details six patients who experienced penetrating trauma with significant iris tissue loss and who chose to have an artificial iris implant. CASE REPORTS: Six patients with traumatic aniridia were enrolled in a single-site, single-surgeon study. They were followed for one year postoperatively. All six were complex cases that had multiple eye problems, such as aphakia, corneal scarring, corneal graft rejection, and retinal detachment. All participants were male. All patients experienced decrease in glare and light sensitivity following artificial iris implant surgery. Two experienced improved best-corrected vision (BCVA). All six patients felt the cosmetic appearance of their affected eye improved. CONCLUSIONS: The artificial iris device provides an effective means of treating traumatic aniridia. Optometrists often work with patients who have experienced a penetrating ocular trauma, with complete or partial aniridia as a complication. In cases in which nonsurgical means are not effective in returning the patient to comfort and productivity, an artificial iris implant should be considered.