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Noninvasive interventions to decrease hospitalization and associated costs for pediatric patients receiving

Stuart L Goldstein1, Carolyn M Smith, Helen Currier

  • 1Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. stuart@bcm.tmc.edu

Journal of the American Society of Nephrology : JASN
|July 23, 2003
PubMed
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Noninvasive monitoring programs significantly reduced hospitalizations for fluid overload/hypertension and vascular access thrombosis in pediatric hemodialysis patients. These advancements also lowered healthcare costs for children on maintenance dialysis.

Area of Science:

  • Pediatric Nephrology
  • Dialysis Technology
  • Healthcare Management

Background:

  • Limited data exist on pediatric hemodialysis hospitalizations and costs.
  • Fluid overload/hypertension (FO/HTN) and vascular access thrombosis (VAT) were primary causes of hospitalization in 1999.
  • Need for effective methods to decrease pediatric maintenance dialysis hospitalizations.

Purpose of the Study:

  • To evaluate the impact of two noninvasive monitoring programs on FO/HTN and VAT hospitalizations.
  • To assess the effect of these programs on healthcare costs in pediatric maintenance hemodialysis patients.
  • To determine if noninvasive technologies can reduce morbidity and costs.

Main Methods:

  • Prospective observational study of 51 pediatric maintenance hemodialysis patients (1999-2001).

Related Experiment Videos

  • Tracked hospitalization rates and costs for FO/HTN and VAT before and after program implementation.
  • Implemented a hematocrit-guided ultrafiltration algorithm and ultrasound dilution vascular access flow monitoring.

    • Main Results:

    • Hematocrit-guided ultrafiltration significantly decreased FO/HTN hospitalizations (64 days in 1999 to 4 days in 2000-2001).
    • Ultrasound dilution monitoring reduced VAT hospitalizations (45 days in 2000 to 21 days in 2001).
    • Both programs maintained acceptable blood pressure control and minimized medication needs.

    Conclusions:

    • Noninvasive monitoring technologies for target dry weight and access flow can significantly decrease pediatric maintenance dialysis patient morbidity.
    • These technologies offer a promising approach to reducing healthcare costs associated with pediatric hemodialysis.
    • Implementation of these noninvasive programs led to substantial improvements in patient outcomes and cost-effectiveness.