Long-term Health Care Utilization and Associated Costs After Dialysis-Treated Acute Kidney Injury in Children,American Journal of Kidney Diseases

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Long-term Health Care Utilization and Associated Costs After Dialysis-Treated Acute Kidney Injury in Children
American Journal of Kidney Diseases ( IF 9.4 ) Pub Date : 2022-08-17 , DOI: 10.1053/j.ajkd.2022.07.005
Cal H Robinson ₁ , Jennifer Ann Klowak ₂ , Nivethika Jeyakumar ₃ , Bin Luo ₃ , Ron Wald ₄ , Amit X Garg ₃ , Danielle M Nash ₃ , Eric McArthur ₃ , Jason H Greenberg ₅ , David Askenazi ₆ , Cherry Mammen ₇ , Lehana Thabane ₈ , Stuart Goldstein ₉ , Samuel A Silver ₁₀ , Rulan S Parekh ₁₁ , Michael Zappitelli ₁₁ , Rahul Chanchlani ₁₂

Affiliation

Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Ontario, Canada.
Department of Pediatrics, Ontario, Canada.
ICES, Ontario, Canada.
Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut.
Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama, Birmingham, Alabama.
Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, British Colombia, Canada.
Department of Pediatrics, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Center for Acute Care Nephrology, Cincinnati Children's Hospital, Ohio.
Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Pediatric Nephrology, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Ontario, Canada; ICES, Ontario, Canada.

Rationale & Objective

Acute kidney injury (AKI) is common among hospitalized children and is associated with increased hospital length of stay and costs. However, there are limited data on postdischarge health care utilization after AKI hospitalization. Our objectives were to evaluate health care utilization and physician follow-up patterns after dialysis-treated AKI in a pediatric population.

Study Design

Retrospective cohort study, using provincial health administrative databases.

Setting & Participants

All children (0-18 years) hospitalized between 1996 and 2017 in Ontario, Canada. Excluded individuals comprised non-Ontario residents; those with metabolic disorders or poisoning; and those who received dialysis or kidney transplant before admission, a kidney transplant by 104 days after discharge, or were receiving dialysis 76-104 days from dialysis start date.

Exposure

Episodes of dialysis-treated AKI, identified using validated health administrative codes. AKI survivors were matched to 4 hospitalized controls without dialysis-treated AKI by age, sex, and admission year.

Outcome

Our primary outcome was postdischarge hospitalizations, emergency department visits, and outpatient physician visits. Secondary outcomes included outpatient visits by physician type and composite health care costs.

Analytical Approach

Proportions with ≥1 event and rates (per 1,000 person-years). Total and median composite health care costs. Adjusted rate ratios using negative binomial regression models.

Results

We included 1,688 pediatric dialysis-treated AKI survivors and 6,752 matched controls. Dialysis-treated AKI survivors had higher rehospitalization and emergency department visit rates during the analyzed follow-up periods (0-1, 0-5, and 0-10 years postdischarge, and throughout follow-up), and higher outpatient visit rates in the 0-1-year follow-up period. The overall adjusted rate ratio for rehospitalization was 1.46 (95% CI, 1.25-1.69; P < 0.0001) and for outpatient visits was 1.16 (95% CI, 1.09-1.23; P = 0.01). Dialysis-treated AKI survivors also had higher health care costs. Nephrologist follow-up was infrequent among dialysis-treated AKI survivors (18.6% by 1 year postdischarge).

Limitations

Potential miscoding of study exposures or outcomes. Residual uncontrolled confounding. Data for health care costs and emergency department visits was unavailable before 2006 and 2001, respectively.

Conclusions

Dialysis-treated AKI survivors had greater postdischarge health care utilization and costs versus hospitalized controls. Strategies are needed to improve follow-up care for children after dialysis-treated AKI to prevent long-term complications.

中文翻译：

透析治疗儿童急性肾损伤后的长期医疗保健利用和相关费用

理由和目标

急性肾损伤 (AKI) 在住院儿童中很常见，并且与住院时间和费用增加有关。然而，关于 AKI 住院后出院后医疗保健利用的数据有限。我们的目标是评估儿科人群经透析治疗的 AKI 后的医疗保健利用率和医生随访模式。

学习规划

回顾性队列研究，使用省级卫生行政数据库。

设置和参与者

1996 年至 2017 年间在加拿大安大略省住院的所有儿童（0-18 岁）。被排除在外的个人包括非安大略省居民；代谢紊乱或中毒者；入院前接受透析或肾移植、出院后 104 天接受肾移植或透析开始日期后 76-104 天接受透析的患者。

接触

透析治疗的 AKI 发作，使用经过验证的卫生管理代码进行识别。AKI 幸存者根据年龄、性别和入院年份与 4 名未接受透析治疗的 AKI 住院对照相匹配。

结果

我们的主要结果是出院后住院、急诊就诊和门诊就诊。次要结果包括按医生类型划分的门诊就诊次数和综合医疗保健费用。

分析方法

≥1 事件的比例和发生率（每 1,000 人年）。综合医疗保健总费用和中位数。使用负二项式回归模型调整比率。

结果

我们纳入了 1,688 名接受透析治疗的 AKI 幸存者和 6,752 名匹配的对照组。接受透析治疗的 AKI 幸存者在分析的随访期间（出院后 0-1、0-5 和 0-10 年，以及整个随访期间）的再住院率和急诊就诊率更高，并且门诊就诊率更高0-1年的随访期。再住院的总体调整比率为 1.46（95% CI，1.25-1.69；P < 0.0001），门诊就诊为 1.16（95% CI，1.09-1.23；P = 0.01）。接受透析治疗的 AKI 幸存者的医疗保健费用也更高。在接受透析治疗的 AKI 幸存者中，肾脏科医生的随访很少（出院后 1 年为 18.6%）。