Pediatric CKD confers higher hospital costs, mortality rate vs other chronic conditions
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A study of children hospitalized in the United States determined those with chronic kidney disease accrued higher costs and had higher rates of mortality than children with other chronic conditions.
According to Zubin J. Modi, MD, of the division of pediatric nephrology at the University of Michigan, and colleagues, the outcomes for children with CKD following hospitalization, as well as what resources they might require while hospitalized, have been understudied and thus “remain unclear.”
“Previous studies have noted the substantial financial stressors within families who have a child with CKD,” they wrote. “While annual Medicare expenditures exceed $50 billion for adult patients with CKD in the United States, similar statistics regarding national health care costs for pediatric CKD are unknown. A few studies have described health care utilization in disease-specific subsets of children with kidney disease, but these are not generalizable to the full population of children with CKD. Lack of basic epidemiological information about this population makes policy and care decisions difficult.”
Contending that no prior study has examined the inpatient CKD population on a large-scale, Modi and colleagues assessed data from the Health Cost and Utilization Project Kids Inpatient Database, including 6,524,745 children with a chronic medical condition (3.9% of the study population had CKD, with age ranging from 29 days and 19 years).
Results showed patients with CKD had a longer length of stay than those without CKD (median of 2.8 days vs. 1.8 days) and that costs were higher in the CKD group. Specifically, the median cost per hospitalization was $8,755 for patients with CKD and $5,016 for those without CKD.
Regarding mortality, researchers observed the proportion of in-hospital mortality for patients with CKD was nearly double the rate of that for patients without CKD (0.5% vs. 0.9%). After discharge, patients with CKD had 51% higher odds of death compared to discharges without CKD. Researchers noted patients with a higher median family income had lower rates of mortality.
“These outcomes seem to be due to the higher complexity of CKD discharges compared to discharges with other chronic illnesses,” they concluded. “Investigation is needed to identify modifiable patient characteristics and health care delivery with the aim of developing and testing interventions to reduce the adverse health outcomes of pediatric CKD in the U.S. It is likely that the costs reported represent only a small portion of pediatric CKD expenditures as much of CKD care is performed on an outpatient basis.”
Modi and colleagues recommend further investigation be done to fully understand the economic burden that pediatric CKD has on families, as well as on the U.S. health care system.
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