Kidney Week

Abstract: PO0496

Critical Care Resource Use in CKD in the Safety-Net Setting

Session Information

• CKD Health Services Research
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Triozzi, Jefferson Lorenzo, Baylor College of Medicine, Houston, Texas, United States

Jefferson Lorenzo Triozzi,

• Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States

Jingbo Niu,

• Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States

Sankar D. Navaneethan,

Background

Chronic kidney disease (CKD) is associated with adverse outcomes among patients with critical illness. There is limited data on the extent of critical care resource use among patients with CKD in safety-net settings.

Methods

We conducted a retrospective cohort study of patients in a safety-net healthcare system with non-dialysis-dependent CKD and critical illness, defined as admission or transfer to the intermediate or intensive care unit. Poisson regression was used to identify risk factors for critical illness based on sociodemographic factors, comorbidities, and baseline stage of CKD. Critical care resource use was extracted from the medical record, including dialysis initiation, ventilatory support, blood products, and vasoactive medications. Results were stratified by baseline stage of CKD.

Results

Out of 1,298 patients with CKD who were hospitalized during a three-year period (stage 3a- 43%, stage 3b- 35%, stage 4- 22%), 495 patients required intermediate or intensive care. In the multi-adjusted model [IRR (95% CI)], critical illness was associated with stage of CKD [stage 3a- 1 (referent), stage 3b- 1.24 (1.10,1.40), stage 4- 1.99 (1.72, 2.30)]. Hispanic and non-Hispanic black race, congestive heart failure, and moderate/severe anemia were also associated with risk of receiving critical care (Table 1).

Conclusion

We report a high burden of hospitalizations requiring critical care resources in a safety-net setting. Notably, a third of patients with CKD stage 4 and critical illness required hemodialysis initiation. Further research is needed to prevent critical illness and the need for critical care resources in patients with CKD.

Table 1. Critical care resource use and factors associated with outcomes in those with different stages of CKD.
¹ Multi-adjusted model for baseline characteristics
^t p<0.001