Patients with AKI treated with dialysis show higher health care utilization, costs
Patients with acute kidney injury treated with dialysis showed higher post-discharge health care utilization and costs compared with hospitalized control patients.
“AKI is common in hospitalized children and is associated with longer length of stay and inpatient costs. However, there is little information about healthcare resource use, costs and follow-up patterns after discharge. This information is important for healthcare system planning and to guide follow-up strategies,” Cal H. Robinson, MD, from the division of pediatric nephrology in the department of pediatrics at The Hospital for Sick Children in Canada, and colleagues wrote. They added, “Our objectives were to determine the extent to which pediatric dialysis-treated AKI patients are at increased risk of post-discharge health care utilization (including re-hospitalizations, emergency department (ED) and outpatient physician visits) and health care costs, versus matched controls.”
In a retrospective cohort study, researchers examined data for 1,688 pediatric patients with dialysis-treated AKI and 6,752 hospitalized matched controls between 1996 and 2017 in Ontario, Canada.
All data were derived from provincial health administrative databases. Researchers matched all patients with AKI to four hospitalized control patients without dialysis-treated AKI by age, sex and admission year. Researchers considered post-discharge health care utilization, such as hospitalizations, ED and outpatient visits, to be the primary outcome of the study.
Using chi-squared tests, researchers determined any statistically significant differences among patients with dialysis-treated AKI and hospitalized controls for at least one health care utilization event per 1,000 person-years. Additionally, researchers conducted negative binomial regression modelling to measure the relationship between dialysis-treated AKI status and health care utilization.
Analyses revealed health care utilization rates and health care costs were higher for dialysis-treated AKI patients compared with controls throughout follow-up and for all outcomes. Researchers identified exposure to dialysis-treated AKI led to an increased risk of re-hospitalization and outpatient physician visits.
“We found that dialysis-treated AKI survivors had higher long-term rates of re-hospitalization, outpatient visits and health care costs, but no difference in ED visits, vs. hospitalized controls. Nephrologist follow-up was infrequent after dialysis-treated AKI. The increasing incidence of dialysis-treated AKI places a significant burden on Ontario’s health care system,” Robinson and colleagues wrote. “Further research should evaluate the impact of dedicated post-AKI clinics and other tertiary prevention strategies on patient outcomes, including health care utilization.”
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