Kidney Week

Abstract: SA-PO0498

Critical Care Use Among Patients with ESKD

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Naing, Aung, Stanford Medicine, Stanford, California, United States

Aung Naing, MD

• Fielding-Singh, Vikram, Stanford Medicine, Stanford, California, United States

Vikram Fielding-Singh, MD

• Chertow, Glenn M., Stanford Medicine, Stanford, California, United States

Glenn M. Chertow, MD, MPH, FASN

• Chen, Cheng, Stanford Medicine, Stanford, California, United States

Cheng Chen, MA, MS

• Graham, Laura A., Stanford Medicine, Stanford, California, United States

Laura A. Graham, PhD, MPH

• Vanneman, Matthew, Stanford Medicine, Stanford, California, United States

Matthew Vanneman, MD

• Rogers, Angela J., Stanford Medicine, Stanford, California, United States

Angela J. Rogers, MD, MPH

• Lin, Eugene, Stanford Medicine, Stanford, California, United States

Eugene Lin, MD, MS, FASN

Background

There are more than 830,000 patients with ESKD in the US, approximately two-thirds of whom receive maintenance dialysis and one-third, kidney transplant recipients. Hospitalization rates are high; however, the degree to which these patients utilize critical care has not been explored. We evaluated critical care utilization among adult patients with ESKD during 2013–2022 using data from the United States Renal Data System (USRDS).

Methods

We included patients 18 years or older with ESKD, defined by the first date of recorded ESKD service. Patients contribute data only during the periods where they had fee-for-service (FFS) Medicare as their primary payor. Critical care was identified using CPT code 99291 with at least one matching institutional claim from the same day to avoid isolated coding errors. The primary outcome was critical care episodes, expressed per person-year. We defined critical care episodes by grouping consecutive critical care days into a single episode. Secondary outcomes included critical care days and percentage of each hospital stay.

Results

We identified 1,242,315 patients with a total of 4,006,297 person-years of observation time. Of eligible patients, 702,840 (56.5%) experienced at least one critical care episode during the study period. We observed 2,118,900 critical care episodes, corresponding to an incidence of 0.53 critical care episodes per person-year. A total of 4,251,700 ICU days were identified, yielding a mean incidence rate of 1.06 ICU days per person-year. The mean number of ICU days was significantly higher for patients receiving dialysis compared with kidney transplant recipients (1.2 versus 0.68). The mean duration of critical care was 2.5 days, with a median of 1 day (IQR 1-2 days). Critical care accounted for a mean of 30% and a median of 25% (IQR 14%-38%) of total hospital days spent in the ICU.

Conclusion

These findings highlight the vulnerability of patients with ESKD to acute decompensation requiring critical care and one element of the degree to which patients with ESKD contribute to overall burden of health care delivery.