Abstract: SA-PO752
Characteristics of ESRD Patients Admitted for Inpatient Dialysis and Its Contribution to Cost of Care
Session Information
- Standard Hemodialysis for ESRD - I
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 601 Standard Hemodialysis for ESRD
Authors
- Ramakrishnan, Madhuri, University of Missouri Kansas City, Kansas CIty, Missouri, United States
- Taduru, Siva sagar, University of Missouri Kansas City, Kansas CIty, Missouri, United States
- Mustafa, Reem, Kansas University Medical Center, Kansas City, Kansas, United States
Background
The United States Renal Data System (USRDS) 2010 report shows that Medicare spent $29 billion, or almost 6% of its annual budget in 2009, on patients with end stage renal disease (ESRD). This covers a variety of expenditure, including hospital admissions. These admissions can be for complications that require emergent dialysis. We aim to present data on admissions of patients with ESRD for complications including hyperkalemia, acidosis and pulmonary edema requiring inpatient dialysis.
Methods
We identified ESRD patients who were admitted with indications of emergent dialysis, and with a length of stay (LOS) < 2 days, and therefore had conceivably no further indication for continued admission. We searched the National Inpatient Sample (NIS) from 2008 – 2014 using International Classification of Diseases Clinical Modification (ICD-9-CM) codes to identify patients with ESRD on long-term dialysis, who were admitted with a primary diagnosis of hyperkalemia, acidosis, or pulmonary edema. We then identified those patients who received dialysis while inpatient, and those whose LOS was < 2 days. We describe categorical variables as proportions and continuous variables as means.
Results
We identified total of 30,918 admissions between 2008 – 2014 for patients with ESRD, who were admitted with indications for emergent dialysis, and had a LOS < 2 days. These represented 1.03% of all-cause admissions in ESRD patients. The patients’ mean age was 52.0 ± 15.6 years and 54% were males. Of these patients, 32.2% were Caucasians, 31.3% African-Americans, and 25.8% Hispanics. Hyperkalemia was the primary indication in 79.2% of cases, pulmonary edema in 12.3%, ESRD in 8%, and acidosis in only 0.5% of cases. 63.6% patients were insured by Medicare, 18.8% by Medicaid, 9.1% by private insurance, and 5.8% were uninsured. 55.9% of these admissions were seen in urban teaching hospitals. The mean total charges were $13,141 ± 9,522 per admission, which amounts to a mean annual charge of $58,041,920.
Conclusion
Our study reports on admissions of ESRD patients with indications for emergent dialysis. We hypothesize that a proportion of which could represent preventable admissions, incurring higher costs than outpatient dialysis. Further studies are needed to identify factors associated with such admissions, and form strategies to prevent them.