Chronic Kidney Disease Increases Hospital Stays for Pediatric Patients

Zubin Modi, MD

The presence of chronic kidney disease (CKD) might be linked to a number of hospital-related negative impacts among pediatric patients, according to a new study.

A team, led by Zubin J. Modi, MD, Susan B. Meister Child Health Research and Evaluation Center, Department of Pediatrics, University of Michigan, identified the prevalence of pediatric chronic kidney disease among hospitalized children in the US, while examining the association of the disease on hospital outcomes.

The investigators examined hospital discharges of children between 28 days and 19 years old with a chronic medical diagnosis in the Health Cost and Utilization Project Kids Inpatient Databases for the years 2006, 2009, 2012, and 2016.

The investigators sought main outcomes of the length of stay, cost, and mortality.

In the study, the investigators used a multivariable analysis using Poisson, Gamma, and logistic regressions for the 3 main outcomes.

Overall, there was a chronic medical condition present in 6.5 million estimated discharges over the course of the study. Of these patients, CKD was present in 3.9% of the discharges and those with chronic kidney disease had a longer length of stay with a median of 2.8 days (IQR, 1.4-6.0) compared to 1.8 (IQR, 1.0-4.4) for those without a chronic kidney disease diagnosis (P <0.001).

Ultimately, the presence of chronic kidney disease was linked to a longer hospital stay (29.9%; 95% CI, 27.2-32.6%), higher cost (61.3%; 95% CI, 57.4-65.4%), and a higher risk of mortality (OR, 1.51; 95% CI, 1.40-1.63).

“Pediatric CKD was associated with longer LOS, higher costs, and a higher risk of mortality compared to hospitalizations with other chronic illnesses,” the authors wrote. “Further studies are needed to better understand the health care needs and delivery of care to hospitalized children with CKD.”

Recently, investigators were able to identify high-risk subgroups of CKD progression.

A team, led by Amanda H. Anderson, PhD, MPH, Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, characterized chronic kidney disease progression across different levels of several risk factors and identified independent risk factors for disease progression among those with and without diabetes.

The researchers identified 30 risk factors for chronic kidney disease progression across sociodemographic, behavioral, clinical, and biochemical domains at baseline.

For patients without and with diabetes the mean eGFR was -1.4 and -2.7 mL/min/1.73m2/year, respectively.

Among the patients with diabetes, the multivariable-adjusted hazard of the composite outcome was approximately two-fold or greater with higher levels of the inflammatory chemokine CXCL 12, the cardiac marker N-terminal pro-B-type natriuretic peptide (NTproBNP) and the kidney injury marker urine neutrophil gelatinase-associated lipocalin (NGAL).

For patients without diabetes, low serum bicarbonate and highr high sensitivity troponin T, NTproBNP, and urine NGAL were all significantly associated with a 1.5-fold or greater rate of the composite outcome.

The study, “Inpatient Pediatric CKD Health Care Utilization and Mortality in the United States,” was published online in the American Journal of Kidney Diseases.