Elsevier

Critical Care Clinics

Volume 28, Issue 1, January 2012, Pages 99-111
Critical Care Clinics

The Economics of Renal Failure and Kidney Disease in Critically Ill Patients

https://doi.org/10.1016/j.ccc.2011.10.006Get rights and content

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Acute Kidney Injury

Acute kidney injury (AKI) is a common problem in the acute care setting in general and in critically ill patients in particular. In hospitalized patients, the incidence of AKI ranges from 5% to 7% and appears to be rising.1, 2, 3, 4 In a multinational study of critically ill patients, the prevalence of AKI requiring dialysis was 5.7%, and among these patients, the mortality rate was 60.3%.5 Patients with AKI also have a higher risk for developing other nonrenal comorbidities,6 and when present

Acute Tubular Necrosis

If AKI recognized too late in its course or if one is not able to reverse the process even in the case of expeditious diagnosis, then AKI may progress to acute tubular necrosis (ATN). In the ATN state, the glomerular filtration rate (GFR) is reduced to the point where drugs that are renally metabolized may have a prolonged presence and action. As a result, levels of drugs are often monitored, for which there is an added cost. During this period, fluid balance is carefully monitored with strict

Resources, Cost Studies, and Economic Evaluations

The treatment of kidney disease in critically ill patients, as previously alluded to, consumes vast sums of scarce resources, and in view of limited budgets and heightened concerns regarding health care costs, it is vital to examine both the costs of care itself in conjunction with the associated outcomes and the inherent cost-effectiveness. The concept of limited resources, by definition, invokes the notion of opportunity costs, a perspective that at some level elevates the issue of cost and

Summary

Although multiple studies explore the consequences and costs of AKI and its treatments, the main cost of AKI is due to the long-term progression to CKD. Progression to CKD requires the follow-up of a nephrologist and health care expenditures to prevent progression to end-stage renal disease. At present, approximately one third of patients with AKI requiring dialysis see a nephrologist within 30 days of discharge.37 This CKD population, especially persons with stages 4 to 5, has low quality of

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