Abstract: FR-PO138

The Burden of Kidney Dysfunction in Hospitalized Patients with Hepatorenal Syndrome in the United States (US): 2009-2015

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Pham, An T, Mallinckrodt Pharmaceuticals, Hampton, New Jersey, United States
  • Jamil, Khurram, Mallinckrodt Pharmaceuticals, Hampton, New Jersey, United States
  • Lodaya, Kunal, Boston Strategic Partners, Boston, Massachusetts, United States
  • Hayashida, David Kazuo, Boston Strategic Partners, Inc., BOSTON, Massachusetts, United States
  • Lovelace, Belinda, Mallinckrodt Pharmaceuticals, Hampton, New Jersey, United States
  • Huang, Xingyue, Mallinckrodt Pharmaceuticals, Hampton, New Jersey, United States
Background

Hepatorenal Syndrome (HRS), the development of functional renal failure in patients with advanced chronic liver disease, is associated with high morbidity and mortality. The objective of this study was to assess the clinical sequelae, cost burden, and cost drivers of HRS from US hospital perspective.

Methods

A retrospective, longitudinal analysis of the CERNER Health Facts® electronic health record (EHR) database from a large network of US hospitals was performed. Adult patients diagnosed with HRS based on ICD-9 code (572.4) between 2009 and 2015 were included in the analysis. Clinical staging and laboratory data were used to assess the health impact of these patients.

Results

We identified 1,571 male (61.8%) and 971 female (38.2%) patients (mean age: 57.9). Overall, the average length of stay was 34.6 days and hospitalized cost was $91,504. Using Kidney Diseases Improving Global Outcomes Acute Kidney Injury (KDIGO®-AKI) staging classification, the average hospitalization cost for patients without AKI was $62,563, in comparison to $143,620 for patients with stage 2 AKI. In addition, when changes in serum creatinine were examined over the duration of the HRS hospitalization, 44.1% had either no change or <20% improvements in serum creatinine from the time of hospital admissions. During the first HRS hospitalization, 36.8% of patients died and average cost of hospitalization was $108,497 for deceased versus $82,048 for a surviving patient. The HRS hospital readmission rate was 33.1%, which was comprised of 13.5% unplanned readmissions and 19.6% planned readmissions. Patients with unplanned readmissions had an average total cost of care of $97,590 in comparison to $76,803 for patients with planned readmissions.

Conclusion

From a hospital perspective, results from this analysis of a large network of US hospital database indicate that HRS is associated with high cost burden along with high rate of readmission and mortality. More importantly, many patients had either limited or no serum creatinine improvement during their hospital stays. Higher disease severity and unplanned re-admissions may be associated with higher cost of care. Together, these results point to a significant unmet medical need in this patient population and the need for additional treatment options to improve patient outcomes.

Funding

  • Commercial Support