Healthcare burden of venous thromboembolism in childhood chronic renal diseases

Abstract

Background Chronic renal diseases (CRD) are associated with ~5% of pediatric venous thromboembolism (VTE) cases, but the epidemiology of VTE in CRD is ill-defined. Methods Children (<18 years) with CRD were identified from MarketScan®. VTE diagnosis during 6 months after the first CRD diagnosis was ascertained. Demographics, healthcare utilization, mortality and co-morbid conditions were assessed. Results 22,877 children with predefined CRD ICD-9-CM codes were identified between April 1, 2003 and June 30, 2012, 0.55% of these children had VTE. In-hospital mortality was more likely in children with VTE compared to those without VTE (11.9% vs. 0.9%; p<0.0001). Healthcare utilization was also significantly higher with VTE (p<0.0001 for: number of inpatient admissions, length of stay, outpatient visits and pharmaceutical claims), and total mean healthcare expenditures for the 6 month follow-up period were 13 times greater in the VTE group ($338,338 (±$544,045) vs. $25,171 (±$90,792); p<0.0001). In a multivariate model infection, hemodialysis and trauma/surgery significantly increased the likelihood of VTE. Conclusions VTE is rare in children with CRD, but is associated with higher mortality and healthcare utilization when present. Among children with CRD, the likelihood of VTE was increased among those with co-morbid, non-renal chronic conditions.

Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

“…Renal comorbidity, which included patients undergoing dialysis and those with renal failure, has previously been reported as a risk factor for catheter-associated venous thrombosis in children. 27–29 GI comorbidities, which included esophageal/gastric/intestinal disease and biliary/liver/pancreatic disease, also increased the risk of VTE. Previously, only inflammatory bowel disease and short bowel syndrome were linked to VTE in children.…”

Prevalence and risk factors for venous thromboembolism in children with sickle cell disease: an administrative database study

“…Chronic medical conditions known to be associated with VTE (namely, congenital heart disease, inflammatory bowel disease, renal disease [including nephrotic syndrome], and history of cancer [leukemia, brain and renal tumors], stroke, and obesity) were also identified using ICD-9-CM codes ( Table 1). [22][23][24][25][26] A diagnosis of these conditions was included in the analysis only if the subject had 2 disease-specific codes during the study period (eg, leukemia would only be included in the analysis if the subject had 2 ICD-9-CM codes specific for leukemia documented during the study period). To investigate age as a risk factor for VTE, we compared age at VTE (for patients with a history of thrombosis) to age at censoring (for those who did not develop VTE).…”

Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

“…Kerlin et al derived an equation that uses 0 or 1 for absence or presence of certain factors (53): $\begin{array}{c}left\text{VET\hspace{0.17em}probability={e^[1.086\hspace{0.17em}(male)+0.595\hspace{0.17em}(asymmetric\hspace{0.17em}extremity)}\\ \text{\hspace{0.17em}+0.643\hspace{0.17em}(CVC)+0.549\hspace{0.17em}(active\hspace{0.17em}cancer)}-\text{1.11\hspace{0.17em}(alternative\hspace{0.17em}diagnosis)}\\ -\text{2.03]}/{1+e^[1.086\hspace{0.17em}(male)+0.595\hspace{0.17em}(asymmetric\hspace{0.17em}extremity)+0.643}\\ \text{\hspace{0.17em}(CVC)+0.549\hspace{0.17em}(active\hspace{0.17em}cancer)}-\text{1.11\hspace{0.17em}(alternative\hspace{0.17em}diagnosis)}-2.03]\}\end{array}$…”

“…Extremity DVTs induce pain and swelling. VTE in patients with renal disease has been associated with 2-fold increase in hospital admissions and 10-fold increase in LOS (53). Neonates have increased risk of chronic renal insufficiency following renal vein thrombosis.…”