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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Resource use and outcomes in patients with dialysis-dependent chronic kidney disease admitted to intensive care
Paul Secombe1,2,3, Pei-Ying Chiang1, Basant Pawar4
1Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
Insights
Patients with chronic kidney disease requiring dialysis in Central Australia did not experience higher mortality or critical care resource use compared to similar patients without this condition. This finding suggests chronic kidney disease on dialysis does not increase the burden of critical illness.
Area of Science:
- Nephrology
- Critical Care Medicine
- Public Health
Background:
- Central Australia faces a high prevalence of chronic kidney disease requiring haemodialysis (CKD5D).
- CKD5D is frequently associated with increased critical care service utilization.
- Understanding the specific needs and outcomes of CKD5D patients in critical care is essential for resource allocation and patient management.
Purpose of the Study:
- To investigate the demographic profiles of CKD5D patients admitted to intensive care in Central Australia.
- To analyze critical care resource utilization and patient outcomes for CKD5D individuals.
- To compare these findings with a matched cohort of patients without CKD5D.
Main Methods:
- A retrospective matched cohort study design was employed.
- Data were sourced from the Centre for Outcome and Resource Evaluation Outcome Measurement and Evaluation Tool (CORE COMET).
- Patients with CKD5D admitted for critical illness between July 2015 and June 2016 were matched with controls without CKD5D. Primary outcome was all-cause mortality; secondary outcomes included critical care and healthcare resource use.
Main Results:
- CKD5D patients constituted 14% of critical care admissions (63 patients).
- Mortality rates were similar between CKD5D patients and matched controls (17% vs. 22%, P=0.50) at median follow-up of 463 days.
- CKD5D patients had a shorter median intensive care unit length of stay (1.3 vs. 2.9 days), despite higher overall healthcare resource use, which was not significantly altered by ICU admission.
Conclusions:
- This study indicates that CKD5D patients in Central Australia do not face an additional mortality burden in critical care settings.
- Resource utilization for critical care among CKD5D patients is comparable to matched non-CKD5D cohorts.
- The findings suggest that CKD5D does not significantly increase the demand on critical care resources in this population.
Background:
Central Australia (CA) has a high prevalence of haemodialysis-dependent chronic kidney disease (CKD5D). CKD5D is associated with an increased need for critical care services.
Aims:
To describe the demographic features, critical care resource use and outcomes of patients with CKD5D requiring intensive care admission in CA.
Methods:
Retrospective matched cohort database study. Patients with CKD5D who required admission for critical illness between 1 July 2015 and 30 June 2016 were identified using the Centre for Outcome and Resource Evaluation Outcome Measurement and Evaluation Tool (CORE COMET) and matched with patients without CKD5D. The primary outcome was all cause mortality. Secondary outcomes explored use of critical care and other ongoing healthcare use.
Results:
There were 621 critical care admissions during the study period. Of these, CKD5D patients comprised 88 admissions (14%), representing 63 patients. Compared to matched controls, these patients had a similar mortality at a median follow up of 463 days (17% vs 22%, P = 0.50) which did not change when patients with an intensive care unit length of stay (ICU LoS) less than 4 days were excluded. CKD5D patients had a shorter median ICU LoS (1.3 vs 2.9). Although those with CKD5D had higher healthcare resource use, the rate of utilisation remained unchanged by their ICU admission.
Conclusions:
This retrospective observational matched cohort study examining the burden of disease amongst CKD5D patients in CA suggests that there is no additional mortality burden in this group, nor do they require significantly higher critical care resources compared to a matched cohort.
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Assessment: