Key result
In patients with chronic kidney disease, end-of-life inpatient encounters were most frequently related to infection, while kidney failure-related encounters were associated with the longest hospital stays and highest costs.
Why the study?
Real-world data reporting healthcare resource utilisation and costs associated with end-of-life care for patients with chronic kidney disease are limited.
Cohort (n=237,734)
Yes
In patients with CKD, end-of-life inpatient encounters are most frequently related to infection, while those related to kidney failure incur the longest hospital stays and highest costs.
Answers are grounded in this paper and cite their sources.
Kidney failure encounters drive highest costs and longest stays in CKD end-of-life care; leaves open whether targeted interventions reduce inpatient burden.
INTRODUCTION: Real-world data reporting healthcare resource utilisation and costs associated with end-of-life care for patients with chronic kidney disease (CKD) are limited. We examined length of hospitalisation and costs associated with end-of-life inpatient encounters using retrospective data from DISCOVER CKD. METHODS: Data on inpatient encounters for patients with CKD aged ≥ 18 years between January 2016 and March 2020 were extracted from the US Premier Hospital Database. Encounters ending in death were identified and grouped by reason for the encounter, using the International Classification of Diseases, Tenth Revision, and by their insurance coverage. Encounters were evaluated overall and stratified according to cardiovascular (CV), kidney failure and infection-related reasons, and by their coverage by commercial, Medicaid, Medicare or other insurers. Length of hospitalisation and total costs were calculated for encounters. RESULTS: Among 237,734 encounters ending in death, the mean [standard deviation (SD)] age was 74.2 (12.4) years, and 45.3% of patients were female. In total, 25,118, 4210 and 76,307 encounters were classified as relating to CV reasons, kidney failure and infection, respectively. Among all encounters, the mean (SD) length of hospitalisation ranged from 9.1 (11.2) (Medicare) to 12.8 (18.4) (Medicaid) days. Across insurers, encounters related to kidney failure were associated with the longest hospitalisations compared with CV and infection [mean range (days): 10.7-15.9 vs. 7.5-10.5 and 8.7-12.7, respectively]. The median [interquartile range (IQR)] total cost of any inpatient encounter was $17,057 ($8040-35,873). Kidney failure-related encounters had higher costs compared with CV and infection [median (IQR), $18,469 ($8673-38,315) vs. $17,503 ($7766-39,693) and $16,403 ($7762-34,910), respectively]. Medicaid-covered encounters had the highest costs of all insurers [median (IQR), $16,189 ($7725-33,443)]. CONCLUSIONS: Among patients with CKD, end-of-life encounters were most frequently related to infection. Encounters relating to kidney failure incurred the highest costs. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04034992.
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Pollock et al. (2022) conducted a cohort in Chronic Kidney Disease (CKD) (n=237,734). End-of-life inpatient encounters was evaluated on Median total cost of end-of-life inpatient encounter (Median $17,057 (IQR $8040-35,873)). In patients with chronic kidney disease, end-of-life inpatient encounters were most frequently related to infection, while kidney failure-related encounters were associated with the longest hospital stays and highest costs.
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