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Original article

Vol. 154 No. 6 (2024)

Evaluation of health care utilisation and mortality in medical hospitalisations with multimorbidity and kidney disease, according to frailty: a nationwide cohort study

DOI
https://doi.org/10.57187/s.3400
Cite this as:
Swiss Med Wkly. 2024;154:3400
Published
22.06.2024

Summary

INTRODUCTION: The impact of impaired kidney function on healthcare use among medical hospitalisations with multimorbidity and frailty is incompletely understood. In this study, we assessed the prevalence of acute kidney injury (AKI) and chronic kidney disease (CKD) among multimorbid medical hospitalisations in Switzerland and explored the associations of kidney disease with in-hospital outcomes across different frailty strata.

METHODS: This observational study analysed nationwide hospitalisation records from 1 January 2012 to 31 December 2020. We included adults (age ≥18 years) with underlying multimorbidity hospitalised in a medical ward. The study population consisted of hospitalisations with AKI, CKD or no kidney disease (reference group), and was stratified by three frailty levels (non-frail, pre-frail, frail). Main outcomes were in-hospital mortality, intensive care unit (ICU) treatment, length of stay (LOS) and all-cause 30-day readmission. We estimated multivariable adjusted odds ratios (OR) and changes in percentage of log-transformed continuous outcomes with 95% confidence intervals (CI).

RESULTS: Among 2,651,501 medical hospitalisations with multimorbidity, 198,870 had a diagnosis of AKI (7.5%), 452,990 a diagnosis of CKD (17.1%) and 1,999,641 (75.4%) no kidney disease. For the reference group, the risk of in-hospital mortality was 4.4%, for the AKI group 14.4% (adjusted odds ratio [aOR] 2.56 [95% CI 2.52–2.61]) and for the CKD group 5.9% (aOR 0.98 [95% CI 0.96–0.99]), while prevalence of ICU treatment was, respectively, 10.5%, 21.8% (aOR 2.39 [95% CI 2.36–2.43]) and 9.3% (aOR 1.01 [95% CI 1.00–1.02]). Median LOS was 5 days (interquartile range [IQR] 2.0–9.0) in hospitalisations without kidney disease, 9 days (IQR 5.0–15.0) (adjusted change [%] 67.13% [95% CI 66.18–68.08%]) in those with AKI and 7 days (IQR 4.0–12.0) (adjusted change [%] 18.94% [95% CI 18.52–19.36%]) in those with CKD. The prevalence of 30-day readmission was, respectively, 13.3%, 13.7% (aOR 1.21 [95% CI 1.19–1.23]) and 14.8% (aOR 1.26 [95% CI 1.25–1.28]). In general, the frequency of adverse outcomes increased with the severity of frailty.

CONCLUSION: In medical hospitalisations with multimorbidity, the presence of AKI or CKD was associated with substantial additional hospitalisations and healthcare utilisation across all frailty strata. This information is of major importance for cost estimates and should stimulate discussion on reimbursement.

References

  1. Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018 Jun;96(6):414–422D. 10.2471/BLT.17.206441 DOI: https://doi.org/10.2471/BLT.17.206441
  2. World Health Organization. The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
  3. Muller M, Huembelin M, Baechli C, et al. Association of in-hospital multimorbidity with healthcare outcomes in Swiss medical inpatients. Swiss Med Wkly. 2021 Feb;151(506):w20405. 10.4414/smw.2021.20405 DOI: https://doi.org/10.4414/smw.2021.20405
  4. Salive ME. Multimorbidity in older adults. Epidemiol Rev. 2013;35(1):75–83. 10.1093/epirev/mxs009 DOI: https://doi.org/10.1093/epirev/mxs009
  5. Waikar SS, Wald R, Chertow GM, Curhan GC, Winkelmayer WC, Liangos O, et al. Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. J Am Soc Nephrol. 2006 Jun;17(6):1688–94. 10.1681/ASN.2006010073 DOI: https://doi.org/10.1681/ASN.2006010073
  6. Paik JM, Patorno E, Zhuo M, Bessette LG, York C, Gautam N, et al. Accuracy of identifying diagnosis of moderate to severe chronic kidney disease in administrative claims data. Pharmacoepidemiol Drug Saf. 2022 Apr;31(4):467–75. 10.1002/pds.5398 DOI: https://doi.org/10.1002/pds.5398
  7. von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct;335(7624):806–8. 10.1136/bmj.39335.541782.AD DOI: https://doi.org/10.1136/bmj.39335.541782.AD
  8. WHO. The word health report 2008.
  9. Healthcare Cost & Utilization Project. Chronic Condition Indicator (CCI) for ICD-10-CM (beta version). 2018. Available from: https://hcup-us.ahrq.gov/toolssoftware/chronic_icd10/chronic_icd10_archive.jsp
  10. Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018 May;391(10132):1775–82. 10.1016/S0140-6736(18)30668-8 DOI: https://doi.org/10.1016/S0140-6736(18)30668-8
  11. Sauerbrei W, Perperoglou A, Schmid M, Abrahamowicz M, Becher H, Binder H, et al. State of the art in selection of variables and functional forms in multivariable analysis-outstanding issues. Diagn Progn Res. 2020;4(1):3. 10.1186/s41512-020-00074-3 DOI: https://doi.org/10.1186/s41512-020-00074-3
  12. Basel University Hospital. Die Universitätsspitäler der Schweiz warnen vor dem finanziellen Kollaps. 2023;
  13. Beck T. Multimorbidität unter SwissDRG: ein Update. Schweizerische Ärztezeitschrift. 25.05.2022 2022;doi:https://doi.org/10.4414/saez.2022.20686 DOI: https://doi.org/10.4414/saez.2022.20686
  14. Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013 May;61(5):649–72. 10.1053/j.ajkd.2013.02.349 DOI: https://doi.org/10.1053/j.ajkd.2013.02.349
  15. Grams ME, Waikar SS, MacMahon B, Whelton S, Ballew SH, Coresh J. Performance and limitations of administrative data in the identification of AKI. Clin J Am Soc Nephrol. 2014 Apr;9(4):682–9. 10.2215/CJN.07650713 DOI: https://doi.org/10.2215/CJN.07650713
  16. Logan R, Davey P, De Souza N, Baird D, Guthrie B, Bell S. Assessing the accuracy of ICD-10 coding for measuring rates of and mortality from acute kidney injury and the impact of electronic alerts: an observational cohort study. Clin Kidney J. 2020 Dec;13(6):1083–90. 10.1093/ckj/sfz117 DOI: https://doi.org/10.1093/ckj/sfz117
  17. Ko S, Venkatesan S, Nand K, Levidiotis V, Nelson C, Janus E. International statistical classification of diseases and related health problems coding underestimates the incidence and prevalence of acute kidney injury and chronic kidney disease in general medical patients. Intern Med J. 2018 Mar;48(3):310–5. 10.1111/imj.13729 DOI: https://doi.org/10.1111/imj.13729
  18. Montgomerie C, Spaak J, Evans M, Jacobson SH. Acute Kidney Injury: Clinical Characteristics and Short-Term Outcomes in 1,519 Patients. Kidney Dis (Basel). 2023 Jan;9(1):39–48. 10.1159/000527299 DOI: https://doi.org/10.1159/000527299
  19. Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al. AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol. 2021 Jan;32(1):151–60. 10.1681/ASN.2020050615
  20. Stewart JA. Adding insult to injury: care of patients with acute kidney injury. Br J Hosp Med (Lond). 2009 Jul;70(7):372–3. 10.12968/hmed.2009.70.7.43116 DOI: https://doi.org/10.12968/hmed.2009.70.7.43116
  21. Schulman IH, Chan K, Der JS, Wilkins KJ, Corns HL, Sayer B, et al. Readmission and Mortality After Hospitalization With Acute Kidney Injury. Am J Kidney Dis. 2023 Jul;82(1):63–74 e1. 10.1053/j.ajkd.2022.12.008 DOI: https://doi.org/10.1053/j.ajkd.2022.12.008
  22. Andrassy KM. Comments on ‘KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease’. Kidney Int. 2013 Sep;84(3):622–3. 10.1038/ki.2013.243 DOI: https://doi.org/10.1038/ki.2013.243
  23. Foundation NK. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;(3):1–150. 10.1038/kisup.2012.73
  24. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013 Jul;382(9888):260–72. 10.1016/S0140-6736(13)60687-X DOI: https://doi.org/10.1016/S0140-6736(13)60687-X
  25. Liang S, Wang Y, Wang WL, Guo XR, Zhang C, Yang C, et al. Characteristics of hospitalized elderly patients with CKD: a comparison between elderly and non-elderly CKD based on a multicenter cross-sectional study. Int Urol Nephrol. 2023 Jul;56(2):625–33. 10.1007/s11255-023-03675-1 DOI: https://doi.org/10.1007/s11255-023-03675-1
  26. Schaeffner E. Smoothing transition to dialysis to improve early outcomes after dialysis initiation among old and frail adults-a narrative review. Nephrol Dial Transplant. 2022 Nov;37(12):2307–13. 10.1093/ndt/gfab342 DOI: https://doi.org/10.1093/ndt/gfab342
  27. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–63. 10.1093/gerona/59.3.m255 10.1093/gerona/59.3.M255 DOI: https://doi.org/10.1093/gerona/59.3.M255
  28. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. 10.1093/gerona/56.3.m146 10.1093/gerona/56.3.M146 DOI: https://doi.org/10.1093/gerona/56.3.M146
  29. Simpson SH, Lin M, Eurich DT. Medication Adherence Affects Risk of New Diabetes Complications: A Cohort Study. Ann Pharmacother. 2016 Sep;50(9):741–6. 10.1177/1060028016653609 DOI: https://doi.org/10.1177/1060028016653609
  30. Hanlon P, Faure I, Corcoran N, Butterly E, Lewsey J, McAllister D, et al. Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis. Lancet Healthy Longev. 2020 Dec;1(3):e106–16. 10.1016/S2666-7568(20)30014-3 DOI: https://doi.org/10.1016/S2666-7568(20)30014-3
  31. Tonelli M, Wiebe N, Manns BJ, Klarenbach SW, James MT, Ravani P, et al. Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System. JAMA Netw Open. 2018 Nov;1(7):e184852. 10.1001/jamanetworkopen.2018.4852 DOI: https://doi.org/10.1001/jamanetworkopen.2018.4852

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