Physician Mayo Clinic Rochester, MN, United States
Disclosure(s):
Shahd AlAli, MD: No financial relationships to disclose
Introduction: Renal dysfunction commonly complicates hypercalcemia and may adversely affect outcomes in patients with hypercalcemia of malignancy (HCM). Nationally representative estimates of acute kidney injury (AKI), dialysis utilization, and associated inpatient outcomes remain limited.
Objective: To evaluate the prevalence of AKI and dialysis utilization in HCM hospitalizations and to compare outcomes by renal complication status.
Methods: Using the 2022 National Inpatient Sample (NIS), we identified adult hospitalizations (age ≥18 years) with hypercalcemia (ICD-10-CM E83.52) and a concurrent diagnosis of malignancy (ICD-10-CM C00–C97). AKI was identified using diagnosis codes (ICD-10-CM N17). Dialysis was identified using ICD-10-PCS procedure codes (5A1D or 3E1M39), with an “acute dialysis” proxy defined as dialysis excluding hospitalizations with a diagnosis of end-stage renal disease (ESRD). Survey-weighted analyses compared inpatient mortality, length of stay (LOS), and total hospital charges by AKI and dialysis status. Multivariable survey-weighted logistic regression assessed the independent association of AKI with mortality and, among AKI hospitalizations, assessed the association of acute dialysis with mortality.
Results: Among 77,289.97 weighted HCM hospitalizations, 46.80% had AKI and 1.73% required acute dialysis. Mortality was higher with AKI (13.59% vs 9.39%) and mean LOS was longer (9.43 vs 8.03 days). Mean hospital charges were also higher with AKI ($130,644 vs $103,439). Patients requiring acute dialysis had markedly higher mortality (34.46% vs 10.95%), longer LOS (17.56 vs 8.53 days), and higher charges ($297,656 vs $113,002). In adjusted analysis, AKI remained independently associated with increased mortality (aOR 1.82, 95% CI 1.63–2.03; p< 0.001). Among hospitalizations with AKI, acute dialysis was independently associated with higher mortality (aOR 3.93, 95% CI 2.89–5.34; p< 0.001).
Conclusion: AKI is common in hospitalizations for HCM and is associated with increased inpatient mortality and healthcare utilization. Although dialysis is infrequently required, it identifies a particularly high-risk subgroup with markedly worse outcomes. These findings highlight the importance of early recognition and management of renal complications to potentially reduce adverse inpatient outcomes in this endocrine emergency.
*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*
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