Health Care Costs Associated with AKI

Collister, David; Pannu, Neesh; Feng, Yang; James, Matthew T.; Hemmelgarn, Brenda R.; Chui, Betty; Manns, Braden; Klarenbach, Scott

doi:10.2215/cjn.00950117

Cited by 89 publications

(78 citation statements)

References 39 publications

(39 reference statements)

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“…Therefore, we did not take the emergency department visits into account in our results. In many diseases, such as acute myocardial infarction, gastrointestinal bleeding, acute kidney injury, and respiratory distress syndrome, outpatient medical costs are often lower than inpatient medical costs [37][38][39][40]. Our stratified analysis revealed that the low COCI group had more inpatient medical costs than the high COCI group.…”

Section: Discussionmentioning

confidence: 75%

Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy

Yang

Yin

Hung

et al. 2020

IJERPH

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Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan's National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.

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Section: Discussionmentioning

confidence: 75%

Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy

Yang

Yin

Hung

et al. 2020

IJERPH

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“…5,6 The health care system shoulders an additional CAN $3700 to $22,000 cost per patient with CI-AKI because of these events. [7][8][9] Strategies that may reduce the incidence of CI-AKI include preprocedural assessment of CI-AKI risk, [10][11][12][13] minimization of iodinated radiocontrast media during procedures, [14][15][16][17][18] and intravenous hydration before and immediately after the procedure. [19][20][21] Unfortunately, consistent uptake of these strategies is highly variable.…”

Section: R Esum Ementioning

confidence: 99%

Clinical Decision Support to Reduce Contrast-Induced Kidney Injury During Cardiac Catheterization: Design of a Randomized Stepped-Wedge Trial

James

Har

Tyrrell

et al. 2019

Canadian Journal of Cardiology

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Background: Contrast-induced acute kidney injury (CI-AKI) is a common and serious complication of invasive cardiac procedures. Quality improvement programs have been associated with a lower incidence of CI-AKI over time, but there is a lack of high-quality evidence on clinical decision support for prevention of CI-AKI and its impact on processes of care and clinical outcomes. Methods: The Contrast-Reducing Injury Sustained by Kidneys (Contrast RISK) study will implement an evidence-based multifaceted intervention designed to reduce the incidence of CI-AKI, encompassing automated identification of patients at increased risk for CI-AKI, pointof-care information on safe contrast volume targets, personalized recommendations for hemodynamic optimization of intravenous fluids, and follow-up information for patients at risk. Implementation will use cardiologist academic detailing, computerized clinical decision

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“…It remains to be seen whether selective candidacy for biomarker use coupled with preventive interventions could spare a patient from AKI and make these tests economically favorable. The median ICU cost for patients with AKI was estimated between $11,000 and $49,000 depending on severity; in 1 year, the incremental cost of AKI in developed nations may exceed $150 million per year . Averting AKI or reducing AKI severity in even one patient could result in significant cost savings that may offset the expense of the diagnostic test.…”

Section: Unanswered Questions and Future Directionsmentioning

confidence: 99%

“…The median ICU cost for patients with AKI was estimated between $11,000 and $49,000 depending on severity; in 1 year, the incremental cost of AKI in developed nations may exceed $150 million per year. [56][57][58] Averting AKI or reducing AKI severity in even one patient could result in significant cost savings that may offset the expense of the diagnostic test.…”

Section: Unanswered Questions and Future Directionsmentioning

confidence: 99%

Innovative Use of Novel Biomarkers to Improve the Safety of Renally Eliminated and Nephrotoxic Medications

et al. 2018

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Over the last decade, the discovery of novel renal biomarkers and research on their use to improve medication effectiveness and safety has expanded considerably. Pharmacists are uniquely positioned to leverage this new technology for renal assessment to improve medication dosing and monitoring. Serum cystatin C is a relatively new, inexpensive, functional renal biomarker that responds more quickly to changing renal function than creatinine and is not meaningfully affected by age, sex, skeletal muscle mass, dietary intake, or deconditioning. Cystatin C has been proposed as an adjunct or alternative to creatinine for glomerular filtration rate assessment and estimation of drug clearance. Tissue inhibitor of metalloproteinase-2·insulin-like growth factor-binding protein 7 ([TIMP-2]·[IGFBP7]) is a composite of two damage biomarkers released into the urine at a checkpoint in mitosis when renal cells undergo stress or sense a future risk of damage. Concentrations of [TIMP-2]·[IGFBP7] increase before a rise in serum creatinine is evident, thus providing insightful information for evaluation in the context of other patient data to predict the risk for impending kidney injury. This article provides a brief overview of novel renal biomarkers being used as a mechanism to improve medication safety including a discussion of cystatin C, as part of drug-dosing algorithms and specifically for vancomycin dosing, and the use of [TIMP-2]·[IGFBP7] for risk prediction in acute kidney injury and drug-induced kidney disease. Select cases of clinical experience with novel renal biomarkers are outlined, and lessons learned and future applications are described.

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Health Care Costs Associated with AKI

Abstract: Severity of AKI, need for dialysis, and lack of kidney recovery are associated with significant health care costs in hospitalized patients and persist a year after admission. Strategies to identify, prevent, and facilitate kidney recovery are needed.

Cited by 89 publications

References 39 publications

Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy

Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy

Clinical Decision Support to Reduce Contrast-Induced Kidney Injury During Cardiac Catheterization: Design of a Randomized Stepped-Wedge Trial

Innovative Use of Novel Biomarkers to Improve the Safety of Renally Eliminated and Nephrotoxic Medications

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