Inpatient Health Care Utilization in the United States Among Children, Adolescents, and Young Adults With Nephrotic Syndrome

Gipson, Debbie S.; Messer, Kassandra L.; Tran, Cheryl L.; Herreshoff, Emily; Samuel, Joyce P.; Massengill, Susan F.; Song, Peter X.‐K.; Selewski, David T.

doi:10.1053/j.ajkd.2012.12.025

Cited by 38 publications

(26 citation statements)

References 29 publications

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“…Despite these limitations, the prevalence of VTE in children with nephrotic syndrome (1.93%) was similar to that reported in recent studies (1–3.6%) where, likewise to this study, passive monitoring for VTE was utilized [25, 26]. However, as recently reviewed by our group, clinicians should be aware that the prevalence of VTE may be much higher than these estimates when active monitoring (i.e.…”

Section: Discussionsupporting

confidence: 88%

Healthcare burden of venous thromboembolism in childhood chronic renal diseases

et al. 2014

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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.

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Section: Discussionsupporting

confidence: 88%

Healthcare burden of venous thromboembolism in childhood chronic renal diseases

et al. 2014

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“…It may be possible that our sample size and the number of serious complications were too small to detect a significant difference. Similar to analyses of the HCUP-KID data [11, 16], serious NS complications were associated with longer hospitalizations. In our analysis, black patients had shorter hospitalizations compared to white patients after controlling for disease status, complications, and other clinical and demographic factors.…”

Section: Discussionsupporting

confidence: 63%

“…A cross-sectional analysis of the Kids' Inpatient Database from the Healthcare Cost and Utilization Project (HCUP-KID) revealed that NS resulted in an estimated 48,700 inpatient days and charges totaling $259 million nationally in the years 2006 and 2009. Furthermore, 16% of the discharges had at least one severe complication, including thromboembolism, septicemia, peritonitis, pneumonia, or diabetes [11]. …”

Section: Introductionmentioning

confidence: 99%

“…There are limited studies on risk factors for increased inpatient usage among pediatric NS patients. Gipson et al identified patient age 15 years or older, black race, higher socioeconomic status, acute renal failure, thromboembolic disease, hypertension, and infections to be associated with higher inpatient charges [11]. No information is available on predicators for hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

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Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

Wang

Yan

Palmer

et al. 2017

International Journal of Nephrology

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There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

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“…The published literature has been limited to the secondary analysis of large data sets, such as the HCUP-KID data set, which rely on discharge diagnosis of AKI. In recent studies that used the HCUP-KID dataset, the rates of AKI in children hospitalized with NS were reported to be 8.5%-9.1% in 2009 (1,17). Here, we report a much higher incidence of AKI of 50.9%, which likely reflects several factors.…”

Section: Discussionsupporting

confidence: 43%

AKI in Children Hospitalized with Nephrotic Syndrome

Rheault¹,

Zhang²,

Selewski³

et al. 2015

Clinical Journal of the American Society of Nephrology

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101

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Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome.Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition.Results AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P,0.001).Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.

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Inpatient Health Care Utilization in the United States Among Children, Adolescents, and Young Adults With Nephrotic Syndrome

Cited by 38 publications

References 29 publications

Healthcare burden of venous thromboembolism in childhood chronic renal diseases

Healthcare burden of venous thromboembolism in childhood chronic renal diseases

Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

AKI in Children Hospitalized with Nephrotic Syndrome

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