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Factors associated with mortality and high treatment expense of adult patients hospitalized with chronic kidney disease in Thailand

Sirirat Anutrakulchai
Sirirat Anutrakulchai
, 
Cholatip Pongskul
Cholatip Pongskul
, 
Dhavee Sirivongs
Dhavee Sirivongs
, 
Pantipa Tonsawan
Pantipa Tonsawan
, 
Kaewjai Thepsuthammarat
Kaewjai Thepsuthammarat
, 
Sutin Chanaboon
Sutin Chanaboon
, 
Supannee Promthet
Supannee Promthet
 and 
Bandit Thinkhamrop
Bandit Thinkhamrop
   | Jan 31, 2017
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Article Category: Original article
Published Online: Jan 31, 2017
Page range: 15 - 24
DOI: https://doi.org/10.5372/1905-7415.1001.460
Keywords
© 2016 Sirirat Anutrakulchai, Cholatip Pongskul, Dhavee Sirivongs, Pantipa Tonsawan, Kaewjai Thepsuthammarat, Sutin Chanaboon, Supannee Promthet, Bandit Thinkhamrop, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Prognostic factors influencing mortality rates of adult Thai patients hospitalized with chronic kidney disease

Variables No. of patients (individuals) Dead individuals and mortality rate (%) Crude odds ratio (95% CI) P Adjusted odds ratio* (95% CI) P
Sex
  Female 66,134 6,814(10.3) 1 1
  Male 62,204 6,941(11.2) 1.10(1.05-1.14) <0.001 1.07(1.03-1.11) 0.001
Age (years)
  19-30 1,869 189(10.1) 1 1
  31-40 4,135 400(9.7) 0.95(0.79-1.14) 0.60 1.13(0.92-1.39) 0.23
  41-50 10,556 1,127(10.7) 1.06(0.90-1.25) 0.47 1.20(1.00-1.45) 0.049
  51-60 23,073 2,318(10.0) 0.99(0.85-1.16) 0.93 1.09(0.91-1.30) 0.36
  61-70 32,837 3,277(10.0) 0.98(0.84-1.15) 0.85 1.08(0.91-1.29) 0.38
  71-80 37,727 4,039(10.7) 1.07(0.91-1.24) 0.42 1.19(0.99-1.41) 0.06
  >80 18,141 2,405(13.3) 1.36(1.16-1.59) <0.001 1.52(1.27-1.81) <0.001
Comorbidities
  Diabetes mellitus (yes/no) 58,427/69,911 6,795(11.6)/6,960(10.0 1.19(1.15-1.23) <0.001 1.13(1.08-1.19) <0.001
  Ischemic heart disease (yes/no) 19,264/109,074 3,178(16.5)/10,577(9.7) 1.84(1.76-1.92) <0.001 1.64(1.55-1.73) <0.001
  Heart failure (yes/no) 18,174/110,164 3,277(18.0)/10,478(9.5) 2.09(2.01-2.18) <0.001 1.42(1.35-1.50) <0.001
  Sepsis (yes/no) 16,792/111,546 6,146(36.6)/7,609(6.8) 7.89(7.58-8.20) <0.001 4.96(4.75-5.19) <0.001
  Pneumonia (yes/no) 13,247/115,091 3,860(29.1)/9,895(8.6) 4.37(4.19-4.56) <0.001 1.81(1.72-1.91) <0.001
  AKI plus preexisting CKD (yes/no) 11,367/116,971 2,972(26.1)/10,783(9.2) 3.49(3.33-3.65) <0.001 1.63(1.54-1.72) <0.001
  Stroke (yes/no) 9,527/118,811 2,071(21.7)/11,684(9.8) 2.55(2.42-2.68) <0.001 2.16(2.03-2.30) <0.001
  Respiratory failure (yes/no) 10,596/117,742 4,707(44.4)/9,048(7.7) 9.60(9.19-10.03) <0.001 4.14(3.94-4.36) <0.001
Complications
Anemia requiring blood Transfusion (yes/no) 38,730/89,608 5,916(15.3)/7,839(8.7) 1.88(1.81-1.95) <0.001 1.21(1.16-1.27) <0.001
  Hyperkalemia (yes/no) 19,165/109,173 3,728(19.5)/10,027(9.2) 2.39(2.29-2.49) <0.001 1.51(1.44-1.59) <0.001
  Volume overload (yes/no) 15,213/113,125 2,831(18.6)/10,924(9.7) 2.14(2.04-2.24) <0.001 1.25(1.18-1.32) <0.001
  Metabolic acidosis (yes/no) 10,561/117,777 2,799(26.5)/10,956(9.3) 3.52(3.35-3.69) <0.001 1.74(1.64-1.84) <0.001

Characteristics of patients hospitalized with chronic kidney disease

Characteristics of admitted CKD patients
Number of adult patients (individuals) 128,338
Number of admissions (times) 236,439
Age (mean ± SD) years 65.5 ± 13.9
Sex (male/female) 1/1.14
Common comorbidities (% of admissions)
  Hypertension 53.1
  Diabetes mellitus 43.0
  Hyperlipidemia 13.2
  Ischemic heart disease 12.4
  Heart failure 10.5
  Gout 8.3
  Sepsis 7.8
  Pneumonia 6.2
  AKI on preexisting CKD 5.1
  Diarrhea 5.1
  Stroke 5.0
  Respiratory failure 4.8
Complications (% of admissions)
  Anemia requiring blood transfusion 24.4
  Hyperkalemia 9.9
  Volume overload 9.3
  Metabolic acidosis 5.0
Dialysis treatment (% of admissions)
  Hemodialysis 7.3
  Peritoneal dialysis 1.9
Length of stay (days)
  Median (25th –75th percentile) 3.0 (2.0-6.0)
Hospital charge (baht)
  Mean ± SD 20,980 ± 126,985
  Median (25th –75th percentile) 7,360 (3,866-16,599)
Mortality (%) 10.7

Factors influencing high hospital charges (>50,000 baht) among Thai adult patients hospitalized with CKD

Variables No. of admissions (times) No. of high cost admission (%) Crude odds ratio (95% CI) P Adjusted odds ratio (95% CI) P
Sex
  Female 126,027 8,490(6.7) 1 <0.001
  Male 110,412 9,662(8.8) 1.31(1.27–1.36) 1.29(1.25–1.34)
Age (years)
  19–30 4,376 405(9.3) 1 1
  31–40 8,392 715(8.5) 0.92(0.80–1.06) 0.24 1.03(0.88–1.20) 0.72
  41–50 22,172 1,682(7.6) 0.81 (0.72–0.92) <0.001 0.90(0.78–1.03) 0.13
  51–60 46,571 3,408(7.3) 0.77(0.68–0.86) <0.001 0.81(0.71–0.92) 0.002
  61–70 62,672 4,324(6.9) 0.72(0.64–0.81) <0.001 0.75 (0.66–0.85) <0.001
  71–80 64,288 5,065 (7.9) 0.82(0.72–0.92) <0.001 0.84(0.74–0.96) 0.01
  >80 27,968 2,553(9.1) 0.95 (0.84–1.07) 0.40 0.95(0.83–1.09) 0.48
Comorbidities
  Hypertension (yes/no) 125,565/110,874 11,037(8.8)/7,115(6.4) 1.38(1.34–1.42) <0.001 1.21(1.17–1.26) <0.001
  Diabetes mellitus (yes/no) 101,664/134,775 8,775 (8.6)/9,377 (7.0) 1.27(1.23–1.31) <0.001 1.20(1.16–1.25) <0.001
  Hyperlipidemia (yes/no) 31,229/205,210 3,449(11.0)/14,703(7.2) 1.51(1.45–1.57) <0.001 1.38(1.32–1.45) <0.001
  Ischemic heart disease (yes/no) 29,272/207,167 4,406(15.1)/13,746(6.6) 2.42(2.33–2.51) <0.001 2.35 (2.24–2.45) <0.001
  Heart failure (yes/no) 24,915/211,524 2,679(10.8)/15,473(7.3) 1.53(1.46–1.60) <0.001 1.13(1.07–1.19) <0.001
  Sepsis (yes/no) 18,528/217,911 4,586(24.8)/13,566(6.2) 4.62(4.44–4.79) <0.001 2.87(2.74–3.00) <0.001
  Pneumonia (yes/no) 14,732/221,707 4,004(27.2)/14,148(6.4) 5.18(4.98–5.40) <0.001 3.18(3.03–3.34) <0.001
  AKI plus preexisting CKD (yes/no) 12,133/224,306 3,351(27.6)/14,801(6.6) 5.09(4.88–5.31) <0.001 2.83 (2.69–2.98) <0.001
  Stroke (yes/no) 11,886/224,553 2,313(19.5)/15,839(7.1) 2.97(2.83–3.12) <0.001 2.41 (2.27–2.55) <0.001
  Respiratory failure (yes/no) 11,347/225,092 3,080(27.1)/15,072(6.7) 5.02(4.80–5.25) <0.001 2.10(1.99–2.22) <0.001
Complications
  Anemia requiring blood Transfusion (yes/no) 57,727/178,712 7,442(12.9)/10,710(6.0) 2.38(2.31–2.46) <0.001 2.13(2.06–2.21) <0.001
  Hyperkalemia (yes/no) 23,505/212,934 2,532(10.8)/15,620(7.3) 1.57(1.51–1.64) <0.001 1.09(1.03–1.14) 0.002
  Metabolic acidosis (yes/no) 11,897/224,542 1,549(13.0)/16,603(7.4) 1.90(1.80–2.00) <0.001 1.03(0.96–1.10) 0.42
Mode of dialysis
  Hemodialysis 17,143/219,296 5,239(30.6)/12,913(5.9) 6.45 (6.22–6.70) <0.001 5.16(4.94–5.39) <0.001
  Peritoneal dialysis 4,584/231,855 1,170(25.5)/16,982(7.3) 4.16(3.89–4.46) <0.001 3.40(3.14–3.69) <0.001

Length of hospital stay and hospital charges for hospitalized patients with chronic kidney disease and comorbidities, complications, and dialysis

Length of stay (days) Total hospital charge (baht) Hospital charge per day (baht)
Median (25th–75th percentile) Mean ± SD Median (25th–75th percentile) Mean ± SD Median (25th–75th percentile)
Comorbidities Hypertension 4(2–7) 23,333 ±151,929 7,759(4,028–17,866) 3,564 ±11,486 2,182(1,465–3,543)
Diabetes mellitus 4(2–7) 23,072 ±165,634 7,836(4,151–17,566) 3,479 ±12,217 2,127(1,444–3,482)
Hyperlipidemia 4 (2–7) 27,754 ±79,165 8,767(4,471–20,767) 4,283 ±11,570 2,232(1,493–3,700)
Ischemic heart disease 4(2–8) 37,732 ±106,752 11,478(5,510–27,252) 5,924 ±15,359 2,729(1,782–4,597)
Heart failure 4(2–8) 28,369 ±107,870 9,920(5,310–21,368) 3,503 ±6,035 2,392(1,642–3,787)
Gout 4 (2–7) 19,727 ±54,788 7,061 (3,709–15,541) 2,989 ±5,738 1,930(1,323–3,095)
Sepsis 6 (3–13) 54,187 ±140,151 19,293 (8,684–19,433) 4,789 ±4,888 3,412(2,054–5,756)
Pneumonia 7(4–14) 63,327 ±163,420 19,308(8,470–55,465) 4,170± 3,747 3,118(1,901–5,143)
AKI on pre-existing CKD 7 (4–14) 57,789 ±127,685 22,363(9,794–55,169) 4,678 ±6,166 3,182(1,995–5,286)
Diarrhea 3(2–6) 17,199 + 55,461 5,557(3,086–11,968) 2,390 ±2,751 1,684(1,223–2,602)
Stroke 5(3–11) 44,983 ±116,448 13,962(6,644–37,092) 4,112 ±6,066 2,860(1,826–1,686)
Respiratory failure 5(2–11) 55,515 ±121,600 23,262(10,459–54,127) 5,923 ±5,509 4,691 (3,260–6,917)
Complications Anemia requiring
blood transfusion 4(2–8) 29,857 ±97,687 9,234(4,591–23,990) 3,569 ±4,830 2,600(1,828–3,950)
Hyperkalemia 4 (2–7) 25,446 ±65,694 9,324(5,151–21,005) 3,775 ±4,978 2,696(1,850–1,246)
Volume overload 4(2–7) 24,277 ±315,227 8,960(4,955–19,631) 3,391 ±21,033 2,372(1,635–3,770)
Metallic acidosis 4(2–8) 27,833 ±63,349 11,010(5,679–25,701) 4,432 ±5,591 2,942(1,866–5,215)
Mode of dialysis Hemodialysis 8(4–15) 66,302 ±245,694 27,847(13,424–61,410) 5,864 ±92,303 3,470(2,301–5,473)
Peritoneal dialysis 8(4–15) 56,072 ±369,690 21,850(10,218–51,175) 6,711 ±177,788 2,904(1,900–4,815)
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