S33 The National Burden of Advanced Chronic Kidney Disease on Hospital Outcomes in Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is a common gastrointestinal condition often requiring hospitalization, with outcomes influenced by numerous comorbidities. Among these, chronic kidney disease (CKD), particularly in its advanced stages, may significantly complicate the clinical course due to fluid imbalance and impaired metabolic regulation. Despite this potential interaction, the impact of advanced CKD on inpatients with AP remains underexplored. This study aims to evaluate the impact of advanced CKD on key inpatient outcomes in patients with AP. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 to 2021 to identify adult patients admitted for AP. Patients were stratified into advanced CKD (eGFR <15 mL/min) and non-advanced CKD (eGFR ≥15 mL/min). Multivariable logistic regression was used to assess the association between advanced CKD and in-hospital mortality, while linear regression analyzed variations in total hospital charges, costs, and length of stay (LOS). The models were adjusted for patient demographics (age, gender, race, residence, median household income), Charlson Comorbidity Index, and hospital characteristics (region, teaching status, bed size). Results: Among 1,643,153.9 acute pancreatitis hospitalizations, 31,040 (1.9%) had advanced CKD. Compared to non-advanced CKD patients, advanced CKD patients were significantly more likely to be Black (42.7% vs 16.2%), have Medicaid (69.1% vs 28.7%), with higher Charlson score (84.3% vs 15.0%), and reside in lower-income quartiles (42.1% vs 31.7%). After multivariable adjustment, advanced CKD was independently associated with increased odds of in-hospital mortality (adjusted odds ratio: 1.37, 95% CI 1.09-1.71, P < 0.01). Furthermore, advanced CKD was associated with significantly higher mean total hospital charges (adjusted coefficient $16,878.29, 95% CI $12,340.69-$21,415.89, P < 0.01), and longer LOS (0.78 days, 0.51-1.04, P < 0.01). Conclusion: Our study identified that increased inpatient mortality and total hospital charges in acute pancreatitis are associated with advanced CKD status. These findings inform the significance of a multidisciplinary approach with nephrologists in these high-risk patients with AP to improve clinical outcomes.