Inpatient Pediatric CKD Health Care Utilization and Mortality in the United States

Abstract

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.

Keywords: Chronic kidney disease (CKD); adolescents; children; chronic illness; health care costs; hospital utilization; hospitalization; in-hospital mortality; inpatient discharge; length of stay (LOS); medical complexity; pediatric.