Trends and outcomes of chronic kidney disease in intensive care: a 5‐year study

Ngu, Kylie; Reid, David A.; Tobin, Antony

doi:10.1111/imj.13231

Cited by 9 publications

(13 citation statements)

References 18 publications

(40 reference statements)

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“…With the slow progression of CKD accompanied by acute and unpredictable exacerbations of clinical problems (Ngu et al . ), concomitant comorbid conditions and multiplicity of treatment pathways (conservative, renal replacement therapies), flexible and extended palliative care support may be required. The current models of PCS which tend to focus on the later stages of decline may not be a good fit for the varied population with CKD.…”

Section: Literature Reviewmentioning

confidence: 99%

“…In a large retrospective Australian study of people who had accessed PCS (n ¼ 12,817), those with renal failure (8.9% of the sample; CKD stage and modality type were not reported) received a median of six days of PCS as compared with 30 days received by those with a cancer diagnosis (56% of the total sample) (Rosenwax et al 2016). With the slow progression of CKD accompanied by acute and unpredictable exacerbations of clinical problems (Ngu et al 2017), concomitant comorbid conditions and multiplicity of treatment pathways (conservative, renal replacement therapies), flexible and extended palliative care support may be required. The current models of PCS which tend to focus on the later stages of decline may not be a good fit for the varied population with CKD.…”

Section: Literature Reviewmentioning

confidence: 99%

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Tracking patients with advanced kidney disease in the last 12 months of life

Bonner

Chambers

Healy

et al. 2018

Journal of Renal Care

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Tracking patients with advanced kidney disease in the last 12 months of life

Bonner

Chambers

Healy

et al. 2018

Journal of Renal Care

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“…high-risk patients can account for a large proportion of healthcare resources [17]. Critical illness is associated with greater length of stay, in-hospital mortality, and risk of dialysis dependence in observational studies among patients with CKD [3,4,18]. Our findings add to a growing field of data on CKD-related hospitalization and extend this to those in low socioeconomic settings for whom limited information is available.…”

Section: Discussionmentioning

confidence: 53%

“…Chronic kidney disease (CKD) is an independent risk factor for hospitalization, and this risk increases with a decline in estimated glomerular filtration rate (eGFR) [1,2]. The utilization of inpatient critical care services is associated with higher costs and poorer outcomes in patients with CKD [3]. Kidney disease, even at early stages, increases the risk for critical illness due to alterations in acid-base homeostasis, electrolyte imbalances, volume dysregulation, immunosuppression, and anemia.…”

Section: Introductionmentioning

confidence: 99%

Hospitalization and Critical Illness in Chronic Kidney Disease

Triozzi¹,

Niu²,

Walther³

et al. 2020

Cardiorenal Med

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Background: Patients with chronic kidney disease (CKD) who are hospitalized with a critical illness are at increased risk for adverse outcomes. We studied the predictors of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 in a safety-net healthcare setting. Methods: A retrospective cohort study was conducted among patients ≥18 years of age with CKD stages 3 and 4 using a CKD registry from a safety-net healthcare system. Hospitalizations with critical illness were identified among patients requiring nonelective admission or transfer to the intermediate or intensive care unit during a 3-year period after the diagnosis of CKD. Poisson regression was used to determine associations between baseline characteristics and hospitalization requiring intermediate or intensive care among all CKD patients and in those with different stages of CKD. Outcomes of these hospitalizations were also tabulated. Results: Among 8,302 patients with CKD stages 3 and 4, 1,298 were hospitalized and 495 required intermediate or intensive care during a 3-year follow-up period. In the adjusted analysis, advanced CKD, Hispanics (incident rate ratio [IRR]: 1.88), non-Hispanic Blacks (IRR: 1.48), presence of congestive heart failure (IRR: 2.09), cardiovascular disease (IRR: 1.57), chronic pulmonary disease (IRR: 1.60), liver disease, malignancy, and anemia were associated with higher risk of hospitalization requiring intermediate or intensive care. The association of age, gender, race/ethnicity, congestive heart failure, anemia, and body mass index with hospitalization requiring intermediate or intensive care differed significantly by CKD stage (p value for interaction term < 0.05). Congestive heart failure and severity of

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“…In Australia CKD is associated with 17% of all hospitalisations [ 5 ]. Ngu et al found that inpatient admissions (IPA) due to CKD in Australia significantly increased over a four-year period from 5.2% to 8.6% of all hospital admissions, and of intensive care admissions from 8.3% to 13.3% [ 11 ]. CKD is often related to, or is an underlying condition in, many other admitted disease groups, such as cardiovascular and diabetes [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

et al. 2018

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BackgroundChronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries’ populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent.MethodsThe goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life. Patients were recruited from a kidney health service (Queensland, Australia) for this prospective, longitudinal study. Data were collected for 12 months (or until death, whichever was sooner) during 2015-17 from administrative health sources. Emergency department presentations (EDP) and inpatient admissions (IPA) (collectively referred to as critical events) were reviewed by two Nephrologists to gauge if the events were avoidable.ResultsParticipants (n = 19) with a median age of 78 years (range 42-90), were mostly male (63%), 79% had CKD stage 5, and were heavy users of health services during the study period. Fifteen patients (79%) collectively recorded 44 EDP; 61% occurred after-hours, 91% were triaged as imminently and potentially life-threatening and 73% were admitted. Seventy-four IPA were collectively recorded across 16 patients (84%); 14% occurred on weekends or public holidays. Median length of stay was 3 days (range 1-29). The median number of EDP and IPA per patient was 1 and 2 (range 0-12 and 0-20) respectively. The most common trigger to both EDP (30%) and IPA (15%) was respiratory distress. By study end 37% of patients died, 63% were known to PCS and 11% rejected a referral to a PCS. All critical events were deemed unavoidable.ConclusionsFew patients avoided using acute health care services in a 12 month period, highlighting the high service needs of this cohort throughout the long, slow decline of CKD. Proactive end-of-life care earlier in the disease trajectory through integrating renal and palliative care teams may avoid acute presentations to hospital through better symptom management and planned care pathways.

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Trends and outcomes of chronic kidney disease in intensive care: a 5‐year study

Abstract: CKD prevalence amongst patients admitted to hospital and ICU is increasing and is associated with worse outcomes. ElixRF may be a useful administrative flag for nephrologist involvement in care and for prompting consideration of advanced care planning.

Cited by 9 publications

References 18 publications

Tracking patients with advanced kidney disease in the last 12 months of life

Tracking patients with advanced kidney disease in the last 12 months of life

Hospitalization and Critical Illness in Chronic Kidney Disease

Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

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