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. 2023 Mar 1;4(3):316-325.
doi: 10.34067/KID.0005552022.

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

Jay L Koyner  1 , Rachel H Mackey  2   3 , Ning A Rosenthal  2 , Leslie A Carabuena  2 , J Patrick Kampf  4 , Jorge Echeverri  5 , Paul McPherson  4 , Michael J Blackowicz  5 , Toni Rodriguez  6 , Aarti R Sanghani  6 , Julien Textoris  7   8
Affiliations

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

Jay L Koyner et al. Kidney360. .

Abstract

Key Points:

  1. 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.

  2. Relative differences in LOS and costs for PS-AKI versus NPS-AKI were similar for intensive care (ICU) and non-ICU patients.

  3. 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.

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Conflict of interest statement

M.J. Blackowicz reports the following: Employer: Baxter; Alexion Pharmaceuticals; and Ownership Interest: Baxter. L.A. Carabuena reports the following: Employer: Premier Inc; Ownership Interest: United Health; and Research Funding: As an employee of Premier, Inc, I have contributed to research projects funded by BioMerieux, Inc, Baxter Healthcare, Inc, AstraZeneca, Amgen, and Alexion. Premier, Inc. receives and manages the funds. J. Echeverri reports the following: Employer: Baxter; Ownership Interest: Baxter; and Honoraria: Baxter. J. Patrick Kampf reports the following: Employer: Astute Medical, Inc. (a bioMerieux company); Ownership Interest: bioMerieux; and Patents or Royalties: Astute Medical, Inc. (a bioMerieux company). J.L. Koyner reports the following: Employer: University of Chicago; Consultancy: Astute Medical/Biomerieux Baxter, Novartis, Mallinckrodt, SeaStar,; Research Funding: Astute Medical; Nxstage medical; Fresenius Medical; NIH; Honoraria: American Society of Nephrology; ISICEM; CSCTR, Acute Disease Quality Initiative (ADQI); Patents or Royalties: Listed on a patent for Pi GST to detect severe AKI following cardiac surgery—with Argutus Medical; Advisory or Leadership Role: Editorial Board of Clinical Journal of American Society of Nephrology (CJASN), American Journal of Nephrology and Kidney360, Scientific Ad Board for the NKF of Illinois; Guard Therapuetics, Novartis; and Speakers Bureau: NxStage Medical.J.L. Koyner reports receiving research fees from bioMerieux and consulting fees from Baxter and bioMerieux. RHM, NAR, and LAC are full-time employees of Premier, Inc., which received payment from bioMerieux to conduct the study, and have no competing interests with respect to the study. R.H. Mackey reports the following: Employer: Premier, Inc.; Research Funding: As an employee of Premier, Inc., I have led research projects funded by bioMerieux, Inc., Baxter Healthcare, Inc., AstraZeneca, Amgen, and Alexion. Premier, Inc. receives and manages the funds.; and Other Interests or Relationships: I have the following unpaid activities: I am a Fellow and volunteer member of the American Heart Association, a volunteer member of the National Lipid Association and ISPOR, and an Associate Editor of the Journal of Clinical Lipidology. P. McPherson reports the following: Employer: Astute Medical Inc (a bioMerieux company); Ownership Interest: bioMerieux; Patents or Royalties: Astute Medical Inc (a bioMerieux company); and Advisory or Leadership Role: Astute Medical Inc (a bioMerieux company). T. Rodriguez reports the following: Employer: bioMerieux; and Research Funding: bioMerieux. N.A. Rosenthal reports the following: Employer: PINC AI Applied Sciences, Premier Inc.; Scopely; Ownership Interest: PINC AI Applied Sciences, Premier Inc.; and Research Funding: All of our research projects are funded by life science companies. A.R. Sanghani reports the following: Employer: Grifols Shared Services North America, Inc.; bioMerieux, Inc. (2020–2022). J. Textoris reports the following: Employer: bioMérieux; Ownership Interest: bioMérieux; Research Funding: bioMérieux; Patents or Royalties: the company I work for holds patent related to diagnostics, in particular in the field of the host immune response. I am an inventor listed on some of them.; and Advisory or Leadership Role: I am employee of a diagnostic company, bioMérieux, and part of the leadership team (as VP, EME Medical Affairs). P. McPherson, J. Patrick Kampf, A.R. Sanghani, J. Textoris, and T. Rodriguez are full-time employees of bioMerieux. M.J. Blackowicz and J. Echeverri are full-time employees of Baxter International with ownership interests. The authors report no other conflicts of interest with this work.

Figures

None
Graphical abstract
Figure 1
Figure 1
Mean length of stay (LOS) and adjusted absolute and relative LOS differences for patients with PS-AKI versus NPS-AKI. *P<0.001 for all comparisons versus NPS-AKI (reference). Covariates for adjusted model are age, sex, race-ethnicity, Charlson Comorbidity Index, hospital characteristics (number of beds, teaching status, region, urban/rural) and admission point of origin, admission type, medical versus surgical patient (categorized by MS_DRG), primary payer and CKD, sepsis, and ICU use.
Figure 2
Figure 2
Mean length of stay (LOS) and adjusted absolute and relative LOS differences for PS-AKI versus NPS-AKI for patients with and without ICU stay during index hospitalization. *P<0.001 for all comparisons versus NPS-AKI (reference). Covariates for adjusted model are age, sex, race-ethnicity, Charlson Comorbidity Index, hospital characteristics (number of beds, teaching status, region, urban/rural) and admission point of origin, admission type, medical versus surgical patient (categorized by MS_DRG), primary payer and CKD, sepsis, and ICU use.
Figure 3
Figure 3
Mean costs and adjusted absolute and relative cost differences for PS-AKI versus NPS-AKI. *P<0.005 for all comparisons versus NPS-AKI (reference). US dollars (USD). Covariates for adjusted model are age, sex, race-ethnicity, Charlson Comorbidity Index, hospital characteristics (number of beds, teaching status, region, urban/rural) and admission point of origin, admission type, medical versus surgical patient (categorized by MS_DRG), primary payer and CKD, sepsis, and ICU use. Models for ICU costs do not adjust for ICU use or sepsis.
Figure 4
Figure 4
Mean costs and adjusted absolute and relative cost differences for PS-AKI versus NPS-AKI for patients with and without ICU stay during index hospitalization. *P<0.001 for all comparisons versus NPS-AKI (reference), except for 30-day outpatient costs among patients with an ICU stay. US dollars (USD). Covariates for adjusted model are age, sex, race-ethnicity, Charlson Comorbidity Index, hospital characteristics (number of beds, teaching status, region, urban/rural) and admission point of origin, admission type, medical versus surgical patient (categorized by MS_DRG), primary payer and CKD, sepsis, and ICU use. Models for ICU costs do not adjust for ICU use or sepsis.
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References

    1. Selby NM, Crowley L, Fluck RJ, et al. Use of electronic results reporting to diagnose and monitor AKI in hospitalized patients. Clin J Am Soc Nephrol. 2012;7:533–540. doi:10.2215/CJN.08970911 - DOI - PubMed
    1. Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol. 2014;9:12–20. doi:10.2215/CJN.02730313 - DOI - PMC - PubMed
    1. Ülger F, Pehlivanlar Küçük M, Küçük AO, et al. Evaluation of acute kidney injury (AKI) with RIFLE, AKIN, CK, and KDIGO in critically ill trauma patients. Eur J Trauma Emerg Surg. 2018;44:597–605. doi:10.1007/s00068-017-0820-8 - DOI - PubMed
    1. Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care. 2014;18:R144. doi:10.1186/cc13977 - DOI - PMC - PubMed
    1. Xu X, Nie S, Liu Z, et al. Epidemiology and clinical correlates of AKI in Chinese hospitalized adults. Clin J Am Soc Nephrol. 2015;10:1510–1518. doi:10.2215/CJN.02140215 - DOI - PMC - PubMed

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