HACs Substantially Elevate Mortality Rates for Chronic Kidney Disease Patients
May 3rd, 2017
ALBERTA, CANADA — While potentially preventable hospital-acquired complications (HAC) are good for no one, they appear to be especially dangerous for chronic kidney disease (CKD) patients, new research warns.
A study published in the Clinical Journal of the American Society of Nephrology suggests that cohort is at a substantially higher risk of early death than patients with normal kidney function.
Past research has found that CKD patients are more at risk of potentially preventable HACs, according to the study, which was led by University of Alberta researchers. To determine the potential consequences, the study team analyzed data on all adults hospitalized from April 2003 to March 2008 in Alberta, finding that, of 536,549 patients overall, 8.5% had CKD, and 9.8% of patients with CKD had at least one potentially preventable HAC.
The mortality rate among inpatient CKD patients with potentially preventable HACs was 17.7% and 6.5% within 90 days after their discharge. That death rate was dramatically higher for those with CKD and a potentially preventable HAC than those without complications: 4.7 times the rate for dying while hospitalized and 1.1 times the rate of dying within 90 days.
"Patients with potentially preventable hospital-acquired complications are at higher risk of adverse clinical outcomes — longer hospital stay, mortality in the hospital and after discharge, and readmission,” explained lead author Babak Bohlouli, a PhD candidate at the University of Alberta. “The magnitude of this association is larger in patients with CKD compared with those without.”
CKD patients developing hospital-associated complications had lengthy hospital stays, averaging 9.86 days, study authors add, and their odds ratio (OR) for readmission was 1.24.
Looking at a cohort including both CKD and patients with normal kidneys, researchers state that the adjusted ORs for mortality were:
- 2.22 for patients with CKD and no preventable HACs,
- 5.26 for patients without CKD and with preventable HACs, and
- 9.56 for patients with both CKD and preventable HACs.
A linked commentary from Eric Young, MD, of the VA Ann Arbor, MI, Healthcare System and the University of Michigan Medical School, urged more research into HACs in patients with kidney disease.
"The study should prompt nephrologists who care for hospitalized patients to review their current practices," Young wrote. "It is possible that the study findings could prompt insurers to introduce specific programs designed to create incentives for hospitals and providers to adopt practices that reduce the risk of complications in patients with chronic kidney disease specifically.”