Abstract: TH-PO534

Cost of Potentially Preventable Hospitalizations among Patients with CKD: A Population-Based Analysis

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Ronksley, Paul E., University of Calgary, Calgary, Alberta, Canada
  • Wick, James, University of Calgary, Calgary, Alberta, Canada
  • Klarenbach, Scott, University of Alberta, Edmonton, Alberta, Canada
  • Manns, Braden J., University of Calgary, Calgary, Alberta, Canada

Group or Team Name

  • Alberta Kidney Disease Network
Background

Prior studies have observed high rates of hospitalization among patients with chronic kidney disease (CKD). We conducted a population-based analysis to determine the proportion and cost of hospitalizations that are potentially preventable and whether this varies by CKD severity.

Methods

We identified all adults (≥18 years) with an outpatient serum creatinine measurement between January 1 and December 31, 2013 in Alberta, Canada. We used KDIGO guidelines to categorize CKD severity (including dialysis-dependent patients) based on measures of albuminuria and eGFR. Patients were then linked to administrative data to capture frequency and cost of hospital encounters, and followed until death or end of study (December 31, 2014). Within each CKD category we calculated the rate, proportion, and cost attributable to potentially preventable hospitalizations as defined by six CKD-related ambulatory care sensitive conditions (ACSCs); heart failure or volume overload, hyperkalemia, malignant hypertension, and diabetes with hyperosmolarity or ketoacidosis.

Results

Of the 1,007,051 adults with eGFR and albuminuria measurements, 157,465 had CKD of which 1.1% were dialysis-dependent. During a median follow-up of 1 year, there were 56,372 hospitalizations among CKD patients resulting in a total cost of $873 million CAD. Adjusted rates of all-cause hospitalization increased linearly with CKD severity with dialysis-dependent patients having 416 hospitalizations per 1,000 person-years and the highest average cost per inpatient encounter ($26,507 [95% CI: $23,504-$29,510]). Overall 3,769 (6.9%) of hospitalizations were for CKD-related ACSCs, with the majority being for heart failure. Adjusted rates of CKD-related ACSCs also increased with CKD severity and were highest among patients with non dialysis-dependent severe CKD (21 hospitalizations per 1,000 person-years). The total cost of potentially preventable hospitalizations was $54 million (6.1% of total cost), with an average cost per encounter of $13,734 (95% CI: $12,956-$14,511).

Conclusion

While only a small proportion of hospital costs among patients with CKD are for potentially preventable hospitalizations, these findings suggest that effective strategies that reduce preventable admissions among CKD patients may lead to significant cost savings.