Children with chronic kidney disease have outsized health burden

October 20, 2020

ANN ARBOR, Mich. - Chronically ill children with kidney disease may spend more time in the hospital, incur larger health care costs and have a higher risk of death compared to pediatric patients hospitalized for other chronic conditions, a new study suggests.

And one of the biggest drivers of these outcomes, researchers found, was the level of medical complexity the young patients faced. Many children with chronic kidney disease also have multiple other chronic health conditions that adversely impact outcomes, including cardiovascular disease, hypertension, diabetes and difficulties in growth.

"Chronic kidney disease is a lifelong health issue that has an outsized burden on children's lives," says lead author Zubin Modi, M.D., pediatric nephrologist at Michigan Medicine C.S. Mott Children's Hospital and researcher with at the Susan B. Meister Child Health Evaluation and Research Center (CHEAR.)

"We wanted to improve our knowledge of this high risk population in order to better support the needs of chronically ill children with kidney disease. Our findings suggest that these patients have very complex health needs, and we need to determine more effective ways to provide them with the care they need before, during and after hospitalization."

Chronic kidney disease includes long term abnormalities of kidney structure or function that may progress to end-stage kidney disease requiring dialysis or a transplant. Children with the condition are also at risk for acute deteriorations in health secondary to infection, dehydration, and side effects associated with medications.

Researchers analyzed national data during 2006, 2009, 2012, and 2016. Of the 6.5 million national pediatric hospital discharges, nearly 4 % involved children with chronic kidney disease, according to the findings published in the .American Journal of Kidney Diseases.

Children with chronic kidney disease spent about 30% longer in the hospital (an average of 2.8 days compared to 1.8 days for those without a chronic kidney disease) with nearly 60% more in hospital expenses ($8,755 per hospitalization compared to $5,016.)

Children with chronic kidney disease were also 50% more likely to die during hospitalization.

"Data on in-hospital mortality for children with chronic illnesses is lacking, but we know that hospitalizations with a chronic kidney disease diagnosis have a higher mortality than those with other chronic condition diagnoses with the exception of heart failure," Modi says.

"The fact that these children are potentially at higher risk of death while hospitalized should prompt providers to closely evaluate management strategies."

That may mean bringing nephrologists in earlier if they are not already involved in patients' care, making sure to avoid medications that could make kidney function worse as well as other steps that will improve care for these patients, Modi notes.

The high health care expenses for hospitalized pediatric patients with end-stage kidney disease, including dialysis, transplantation, and associated complications may be comparable to hospitalized heart failure patients, authors say.

Kidney disease may be associated with more medical complexities, authors say. The causes of chronic kidney disease in children include genetic disorders, congenital anomalies that may be part of a multi-organ system syndrome, and systemic inflammatory disorders. A recent study from the UK reported that adult kidney disease patients also have a greater degree of medical complexity than patients seen by any other specialty.

"Chronic kidney disease can be a devastating illness with many long-term consequences," Modi says. "Some features of chronic kidney disease that start during childhood will have a significant impact on patients' lives through adulthood.

"We need further studies to better understand the health care needs and delivery of care to hospitalized children with chronic kidney disease in order to optimize health outcomes."

Michigan Medicine - University of Michigan

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to