Dr Vishal Diwan1,2, Dr JENNY ZHANG1,2, Dr ZAIMIN WANG1,2, Dr HELEN HEALY1,2,3, Prof WENDY HOY1,2, CKD.QLD COLLABORATIVE1,2,3
1Faculty of Medicine, The University Of Queensland, Herston, Brisbane, Australia, 2NHMRC CKD.CRE and CKD.QLD, The University of Queensland, Herston, Brisbane, Australia, 3Kidney Health Services, Metro North Hospital and Health Service, Queensland Health, Herston, Brisbane, Australia
Aim:
To analyse the patterns of hospitalisations among non-dialysis CKD patients.
Background:
Chronic kidney disease (CKD) patients have higher hospital costs than non-CKD patients in Australia (average annualised cost: $1829 in 2012), but little is known about the diagnoses/patterns of hospitalisations before death or starting kidney replacement therapy.
Methods:
We analysed hospitalisations among 7,221 CKD patients enrolled in CKD.QLD registry from 10 public renal clinics in Queensland, Australia. They were followed for a total of 25,390 person-years, from enrolment, between May 2011 and until they started KRT or died, or the censor date of 30th June 2018. Queensland Health supplied data on public hospital admissions with ICD-10-AM codes, costs, and outcomes (death and KRT). For some conditions we grouped several ICD-10AM codes together into a single “causal” category.
Results:
81% patients were admitted once or more, contributing to 40,566 admissions, costing $226.3 million, with an average per-person year of 1.6 admissions and cost of $8,915. 59% of admissions were 1-day admissions, although they constituted only 16% of total costs. Neoplasm/cancers constituted the greatest proportion of 1-day admissions (15.3%), followed by anaemia (9%) and kidney-related admissions (8.6%). 41% of admissions were >1-day admissions, which represented 84% of total costs. Leading causes were cardiovascular disease (CVD) (19%), followed by respiratory (11%) and kidney-related (8.4%). Readmissions within 30 days of discharge constituted 41.4% of all admissions and 45% of total costs. Of these readmissions, 46.2% were for the same primary diagnosis, while 56.4% were 1-day admissions.
Conclusion:
The hospital burden is high reflecting great burden of morbidities in these CKD patients. One avenue for hospitalisation minimisation is preventing readmissions for the same diagnosis following complex (>1 day) hospitalisations.
Biography:
I completed my PhD (Pharmacology) in 2013 from the University of Queensland and started working with CKD.QLD in 2018, where I work as a research manager for this state-wide clinical research organisation. The primary focus of my research is kidney diseases, particularly hospital admissions, cost, and primary causes of hospitalisations among non-dialysis patients and how they differ among Indigenous and non-Indigenous CKD patients. I am also interested in identifying the primary reasons for the significant cost burden in non-dialysis CKD patients.