Complexity and Health Care Utilization in Infant ESKD

Abstract

Background: Dialysis in neonates with ESKD is often associated with multiple comorbidities and the need for more intensified dialysis regimens. With recent advances in prenatal interventions and infant specific KRT, survival of neonates with ESKD has improved over the last decade. Little is known however about the impact on the health care system of improved survival in this population. Our primary aim was to investigate healthcare utilization in infants with ESKD.

Methods: We conducted a retrospective review of infants with ESKD started on KRT during their initial neonatal admission at Texas Children's Hospital (TCH) from 2011 to 2022. The primary inclusion criteria were patients who initiated chronic dialysis in the Neonatal Intensive Care Unit (NICU) at TCH and survival to discharge. Data abstracted included patient demographics, number of hospitalizations and length of stays (LOS), comorbidities, pediatric sub-specialist care, and gross hospital charges related to the initial hospitalization, dialytic care, and care post-discharge up to the age of 2 years.

Results: 19 patients initiated dialysis in the NICU and were discharged on chronic dialysis: 68% were male, 79% had a gestational age ≥ 37 weeks, and 90% had a birth weight ≥2500 g. The average LOS for the initial hospitalization was 200 days (standard deviation of 48 days) with an average of 8 subspecialty consults. There were on average 5 admissions prior to age 2 years and 15 average outpatient visits per patient. The median cost of care for the initial hospitalization was $1.2 million with dialysis accounting for 16% of the total cost. The median aggregate cost of care post-discharge until age 2 years was $467,607.

Conclusions: Infant ESKD is associated with significant healthcare utilization including hospitalizations, on-going non-nephrology sub-specialty care, and significant financial expenditures. Further investigation of healthcare utilization in this patient population can help guide the appropriate allocation of resources to support care delivery.