The Economics of Renal Failure and Kidney Disease in Critically Ill Patients
Section snippets
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
References (74)
- et al.
Hospital-acquired renal insufficiency: a prospective study
Am J Med
(1983) - et al.
Hospital-acquired renal insufficiency
Am J Kidney Dis
(2002) - et al.
Risk factors and outcome of hospital-acquired acute renal failure: clinical epidemiologic study
Am J Med
(1987) - et al.
Mortality after acute renal failure: models for prognostic stratification and risk adjustment
Kidney Int
(2006) - et al.
Has mortality from acute renal failure decreased?A systematic review of the literature
Am J Med
(2005) - et al.
Renal blood flow in experimental septic acute renal failure
Kidney Int
(2006) - et al.
Detection of renal blood flow abnormalities in septic and critically ill patients using a newly designed indwelling thermodilution renal vein catheter
Chest
(1990) - et al.
Acute renal failure after cardiac surgery: evaluation of the RIFLE classification
Ann Thorac Surg
(2006) - et al.
Outcomes in patients with normal serum creatinine and with artificial renal support for acute renal failure developing after coronary artery bypass grafting
Am J Cardiol
(2004) - et al.
Economic consequences of renal dysfunction among cardiopulmonary bypass surgery patients: a hospital-based perspective
Value Health
(2003)
Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality
Am J Med
Uncomplicated acute renal failure and hospital resource utilization: a retrospective multicenter analysis
Am J Kidney Dis
The severity of acute kidney injury predicts progression to chronic kidney disease
Kidney Int
Outcomes following diagnosis of acute renal failure in U.S. veterans: focus on acute tubular necrosis
Kidney Int
Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal
Kidney Int
Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial
Lancet
Non-renal indications for continuous renal replacement therapy
Kidney Int
Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial
Lancet
Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies
Am J Kidney Dis
A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure
Kidney Int
Development of a continuous renal replacement program in critically ill patients
Am J Surg
CRRT in the area of cost containment: is it justified?
Am J Kidney Dis
Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis
Am J Kidney Dis
Health-related quality of life and estimates of utility in chronic kidney disease
Kidney Int
Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study
Am J Kidney Dis
Biomarkers in acute and chronic kidney disease
Curr Opin Nephrol Hypertens
Acute renal failure in critically ill patients: a multinational, multicenter study
JAMA
The epidemiology of acute renal failure: 1975 versus 2005
Curr Opin Crit Care
Acute kidney injury, mortality, length of stay, and costs in hospitalized patients
J Am Soc Nephrol
Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes
Clin J Am Soc Nephrol
Prognostic factors in acute renal failure due to sepsisResults of a prospective multicentre study
Nephrol Dial Transplant
Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study
J Am Soc Nephrol
Costs and outcomes of acute kidney injury (AKI) following cardiac surgery
Nephrol Dial Transplant
The epidemiology of cardiac surgery-associated acute kidney injury
Int J Artif Organs
Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery
Circulation 21
Contrast-induced nephropathy: what are the true clinical consequences?
Clin J Am Soc Nephrol
The effect of acute renal failure on mortality: a cohort analysis
JAMA
Cited by (22)
Association between exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prior to septic shock and acute kidney injury
2017, Medicina IntensivaCitation Excerpt :Patients with acute kidney injury (AKI) have a higher risk of short-term and long-term mortality and of chronic kidney injury and are also a significant healthcare burden.1–4
A comparison of acute kidney injury classification systems in sepsis
2016, NefrologiaCitation Excerpt :Acute kidney injury (AKI) is one of the most serious complications in hospitalised patients. AKI patients are at increased risk of death, both short and long term, at increased risk of developing chronic kidney disease, and they consume a substantial amount of healthcare resources.1–9 Close to half of all cases of AKI in critically ill patients are caused by sepsis.10,11
Variable cost of ICU care, a micro-costing analysis
2016, Intensive and Critical Care NursingCitation Excerpt :In our department we use continuous dialysis as the only modality. According to the literature dialysis using either continuous, intermittent or a hybridic method has consistently been related to a higher cost, even though intermittent dialysis seems advantageous in economic terms (Parikh and Shaw, 2012). Length of stay has consistently been regarded as the main cost-driver and reducing ICU stay has been sought as the most fundamental intervention in order to reduce expenses (Cox et al., 2007).
Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: A population-based cohort study
2015, American Journal of Kidney DiseasesKidney Failure and Liver Allocation: Current Practices and Potential Improvements
2015, Advances in Chronic Kidney DiseaseCitation Excerpt :The 29 recipients who received emergent, unplanned RRT experienced significantly more intraoperative complications including arrhythmias and post-reperfusion syndrome and higher 30-day graft loss (28% vs 10%, P = .004) than both other groups combined.76 Guidelines identifying patients undergoing liver transplantation who would benefit from ioRRT are needed as routine use significantly increases health care costs and resource utilization in an economically burdened health care system.77,78 Furthermore, whether ioRRT in patients receiving liver transplantation alone who were borderline candidates for SLK transplantation (ie, preoperative hemodialysis for 4-8 weeks) preserves native kidney function needs further exploration.
Liver transplantation in recipients receiving renal replacement therapy: Outcomes analysis and the role of intraoperative hemodialysis
2014, American Journal of Transplantation