Risk of Hospital-Acquired Complications in Patients with Chronic Kidney Disease

Abstract

Background and objectives Unintended injuries or complications in hospitalized patients are common, potentially preventable, and associated with adverse consequences, including greater mortality and health care costs. Patients with CKD may be at higher risk of hospital-acquired complications (HACs).Design, setting, participants, & measurements Adults from a population-based cohort (Alberta Kidney Disease Network) who were hospitalized from April 1, 2003, to March 31, 2008, made up the study cohort. Kidney function was defined using outpatient eGFR and proteinuria (protein-to-creatinine ratio or dipstick) in the year before index hospitalization. Comorbid conditions were identified using validated algorithms applied to administrative data. A specific diagnostic indicator was used to identify HACs. Complications were classified into clinically homogeneous groups and subclassified as potentially preventable (p-HACs) or always preventable (a-HACs). Multivariable logistic regressions models were used to examine the association of CKD with HACs, accounting for confounders.Results Of 536,549 patients, 8.5% had CKD; those with CKD were older and more likely to be admitted for circulatory system diseases than those without CKD. In fully adjusted models, the odds ratio (OR) of any hospital complication in patients with CKD (reference: no CKD) was 1.19 (95% confidence interval [95% CI], 1.18 to 1.26); there was a graded relation between the risk of HACs and CKD severity, with an OR of 1.81 (95% CI, 1.51 to 2.17) in those with the most severe CKD (eGFR, 15-29 ml/min per 1.73 m 2 and proteinuria, .30 mg/mmol). Findings were similar for p-HACs (OR, 1.20 [95% CI, 1.16 to 1.24] and 1.78 [95% CI, 1.43 to 2.11], respectively). The a-HACs had similar point estimates.Conclusions The presence of CKD and its severity are associated with a higher risk of HACs, including those considered preventable. Targeted strategies to reduce complications in patients with CKD admitted to the hospital should be considered.

Adverse Outcomes Associated with Preventable Complications in Hospitalized Patients with CKD

“…An analysis of data from the Veterans Health Administration for 2004-2005, demonstrated that patients with CKD had a higher risk for several HACs compared with patients with normal kidney function (adjusted incidence rate ratio, 1.19; 95% CI, 1.13 to 1.25) (8). Similarly, our previous work examining a population-based cohort found that patients with CKD had an OR of preventable HACs of 1.20 (95% CI, 1.16 to 1.24) (9). As CKD is readily identifiable using routine and commonly performed laboratory tests, targeting patients with CKD to prevent complications may be feasible.…”

“…Comorbid conditions, including cancer, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, dementia, diabetes with complications and without complications, HIV/AIDS, metastatic solid tumor, myocardial infarction, mild liver disease, moderate/severe liver disease, para/hemiplegia, peptic ulcer disease, peripheral vascular diseases, and rheumatologic disease were identified using validated algorithms applied to hospitalization discharge abstracts and physician claims data (9,13). The reason for hospitalization was categorized into 16 homogeneous groups using the International Classification of Disease version 10 Canadian Modifications (ICD 10 CA) (Supplemental Appendix A).…”

“…Hospitalization is common among patients with CKD, and may confer susceptibility to HACs because of increased risk of bleeding, electrolyte abnormalities, and adverse drug effects, among others. Studies conducted in the United States and Canada have demonstrated that the presence of CKD is associated with a greater risk of potentially preventable HAC than patients with normal kidney function (8,9). Targeting prevention efforts on patients at high risk of HAC, such as those with CKD, readily identified through commonly conducted laboratory tests, may be warranted.…”

Patient’s and physician’s awareness of kidney disease in coronary heart disease patients – a cross-sectional analysis of the German subset of the EUROASPIRE IV survey

“…Patients with kidney disease are also at a higher risk for complications in hospital stays for CHD and impaired prognosis after discharge [ 42 , 43 ]. Causes for affected kidney function are multifactorial, including acutely reduced renal perfusion in myocardial infarction, nephrotoxic contrast application during catheter interventions, but also in elective CABG surgery [ 25 ].…”

Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD

“…Adults with non-dialysis-dependent chronic kidney disease (NDD-CKD) are at increased risk for hospitalization [1][2][3][4][5][6][7], and as their CKD progresses, their risk of hospitalization increases [1, 3-5, 7, 8]. Once hospitalized, patients with NDD-CKD are more likely than their non-CKD counterparts to suffer from a preventable hospital-acquired condition [9], which heightens their risk of in-hospital death, prolonged length of stay, or readmission within 90 days [10]. Like patients with NDD-CKD, older adults also face increased risk of adverse events during hospitalization [11], often followed by disability and loss of independence [12], which deserves special attention given that maintaining independence is the top health outcome priority for older adults with advanced NDD-CKD [13].…”