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Inpatient Pediatric CKD Health Care Utilization and Mortality in the United States
Zubin J Modi1, Anne Waldo2, David T Selewski3
1Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI; Susan B. Meister Child Health Research and Evaluation Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Insights
Pediatric chronic kidney disease (CKD) significantly increases hospital length of stay, costs, and mortality risk in children. This highlights the substantial burden of CKD on pediatric inpatient care and outcomes.
Area of Science:
- Pediatric Nephrology
- Health Services Research
- Epidemiology
Background:
- The impact of pediatric chronic kidney disease (CKD) on inpatient healthcare utilization remains largely unknown.
- Understanding these impacts is crucial for resource allocation and patient care strategies.
Purpose of the Study:
- To determine the prevalence of pediatric CKD among hospitalized children in the United States.
- To analyze the association between pediatric CKD and key hospital outcomes, including length of stay, cost, and mortality.
Main Methods:
- A cross-sectional analysis of national pediatric discharge data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (2006-2016).
- Inclusion criteria encompassed children aged over 28 days to 19 years with a chronic medical diagnosis.
- Multivariable regression models (Poisson, gamma, logistic) were employed to assess the association of CKD with length of stay, cost, and mortality, respectively.
Main Results:
- Chronic kidney disease (CKD) was identified in 3.9% of pediatric discharges with chronic medical conditions.
- Hospitalizations with CKD showed a significantly longer length of stay (29.9% longer), higher costs (61.3% higher), and increased mortality risk (OR 1.51) compared to those without CKD.
- Median length of stay was 2.8 days for CKD patients versus 1.8 days for non-CKD patients, with median costs of $8,755 vs $5,016.
Conclusions:
- Pediatric CKD is associated with significantly increased length of stay, healthcare costs, and mortality risk among hospitalized children.
- These findings underscore the considerable burden of CKD on pediatric inpatient care.
- Further research is recommended to explore the specific healthcare needs and care delivery for hospitalized children with CKD.
Rationale & Objective:
The impact of chronic kidney disease (CKD) on inpatient health care use is unknown. This study aimed to describe the prevalence of pediatric CKD among children hospitalized in the United States and examine the association of CKD with hospital outcomes.
Study Design:
Cross-sectional national survey of pediatric discharges.
Setting & Participants:
Hospital discharges of children (aged>28 days to 19 years) with a chronic medical diagnosis included in the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2006, 2009, 2012, and 2016.
Predictor:
Presence of primary or coexisting CKD as identified by diagnosis codes.
Outcomes:
Length of stay (LOS), cost, and mortality.
Analytical Approach:
Multivariable analysis using Poisson, gamma, and logistic regressions were performed for LOS, cost, and mortality, respectively.
Results:
A chronic medical condition was present in 6,524,745 estimated discharges during the study period and CKD was present among 3.9% of discharges (96.1% without CKD). Those with CKD had a longer LOS (median of 2.8 [IQR, 1.4-6.0] days compared with 1.8 [IQR, 1.0-4.4] days for those without a CKD diagnosis; P<0.001). Median cost was higher in the CKD group compared with the group without CKD, at $8,755 (IQR, $4,563-18,345) and $5,016 (IQR, $2,860-10,109) per hospitalization, respectively (P<0.001). Presence of CKD was associated with a longer LOS (29.9% [95% CI, 27.2%-32.6%] longer than those without CKD), higher cost (61.3% [95% CI, 57.4%-65.4%] greater than those without CKD), and higher risk for mortality (OR, 1.51 [95% CI, 1.40-1.63]).
Limitations:
Lack of access to and adjustment for confounders including patient readmission and laboratory data.
Conclusions:
Pediatric CKD was associated with longer LOS, higher costs, and higher risk for mortality compared with hospitalizations with other chronic illnesses. Further studies are needed to better understand the health care needs and delivery of care to hospitalized children with CKD.
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