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 profile CKD-related and non-CKD related hospitalisations in non-dialysis chronic kidney disease (CKD) patients.
Background:
CKD occurs with, or leads to, several other health conditions requiring hospitalisations. Little is known about the non-dialysis/non-CKD hospitalisations.
Methods:
We analysed primary causes of hospitalisations among 7,221 CKD patients enrolled in CKD.QLD registry from 10 public renal clinics in Queensland, Australia. Patients were followed from enrolment, between May 2011 until starting KRT or death, or the censor date of 30th June 2018. Queensland Health supplied data on hospital admissions with ICD-10-AM codes, hospital days and costs. ICD-10AM chapters 14 (kidney/genitourinary), 21 (rehabilitation/waiting/pharmacotherapy/dialysis preparation) and 4 (endocrine/nutritional/metabolic disorders) contained some CKD-related codes. These were extracted/combined into CKD.QLD’s “CKD-related” category.
Results:
In chapters 14, 4 and 21, 61%, 25% and 20% of admissions were CKD-related. They constituted 4.7%, 1.3% and 2.4% respectively of all admissions. CKD.QLD’s “CKD-related” category represented 8.5% of total admissions, 7.3% of hospital days, and 8.6% of total costs. ~60% of these admissions were one-day admissions. Admissions not directly related to CKD constituted 91.5% of total admissions, 92.7% of hospital days, and 91.5% of total costs. ~59% of these were one-day admissions, but most hospital days and costs were driven by longer admissions, with cardiovascular and respiratory diseases as leading causes. After annualising CKD-related vs non-CKD hospital episodes, the number of admissions were 0.1 vs 1.5, hospital days 0.4 vs 5.7 and costs $764 vs $8,153.
Conclusion:
The major burden of hospitalisations and costs of these patients is driven by their serious co-morbidities, which are not directly related to, although maybe conflated by, their CKD. Minimisation of these complications and progression is a powerful management challenge.
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.