Health Care Resource Utilization and Costs of Persistent Severe Acute Kidney Injury (PS-AKI) Among Hospitalized Stage 2/3 AKI Patients. Issue 3 (March 2023)

• Record Type: Journal Article
• Authors: Koyner, Jay L.; Mackey, Rachel H.; Rosenthal, Ning A.; Carabuena, Leslie A.; Kampf, J. Patrick; Echeverri, Jorge; McPherson, Paul; Blackowicz, Michael J.; Rodriguez, Toni; Sanghani, Aarti R.; Textoris, Julien
• Is Part Of: Kidney360. Volume 4:Issue 3(2023)
• Page Start: 316
• Page End: 325
• Publication Date: 2023-03
• Subjects: Acute Kidney Injury and ICU Nephrology -- costs -- health care resource utilization -- persistent severe acute kidney injury -- severe acute kidney injury; 616.61
• DOI: 10.34067/KID.0005552022
• Languages: English
• ISSNs: 2641-7650

Abstract

Abstract : Abstract : Key Points: Among hospitalized patients with stage 2/3 AKI, persistent severe acute kidney injury (PS-AKI) is associated with significantly longer length of stay (LOS) and higher costs during index hospitalization and 30 days postdischarge. Relative differences in LOS and costs for PS-AKI versus NPS-AKI were similar for intensive care (ICU) and non-ICU patients. Preventing PS-AKI among patients with stage 2/3 AKI may reduce hospital LOS and costs. Background: Persistent severe acute kidney injury (PS-AKI) is associated with worse clinical outcomes, but there are no data on costs of PS-AKI. We compared costs and health care resource utilization for inpatients with PS-AKI versus not persistent severe AKI (NPS-AKI) overall and by ICU use. Methods: This retrospective observational study included 126, 528 adult US inpatients in the PINC AI Healthcare Database (PHD), discharged from January 1, 2017, to December 31, 2019, with KDIGO stage 2 or 3 AKI (by serum creatinine [SCr] criteria) during hospitalization, length of stay (LOS) ≥3 days, and ≥3 SCr measurements. Patients were categorized as PS-AKI (defined as stage 3 AKI lasting ≥3 days or with death within 3 days or stage 2/3 AKI (by SCr criteria) with dialysis within 3 days) or NPS-AKI. Generalized linear model regression compared LOS and costs during index hospitalization (total cohort) and 30 days postdischarge (survivors of index hospitalization), adjusted for patient, hospital, and clinical characteristics. Results: Among 126, 528 patients with stage 2/3 AKI, 30, 916 developed PS-AKI. In adjusted models, compared with NPS-AKI, patients with PS-AKI had 32% longer total LOS (+3.3 days), 45% longer ICU LOS (+2.6 days), 46% higher total costs (+$13, 143), 58% higher ICU costs (+$15, 908), and during 30 days postdischarge 13% longer readmission LOS (+1.0 day), 22% higher readmission costs (+$4049), and 12% higher outpatient costs (+$206) ( P <0.005 for all). Relative LOS and cost differences for PS-AKI versus NPS-AKI were similar for ICU (n=57, 947) and non-ICU ( n =68, 581) patients. Conclusions: Among hospitalized patients with stage 2/3 AKI, PS-AKI was associated with significantly longer LOS and higher costs during index hospitalization and 30 days postdischarge, overall, and in ICU and non-ICU patients. Preventing PS-AKI among patients with stage 2/3 AKI may reduce hospital LOS and costs.