Paula López-Sánchez1, José Portolés2, Leyre Martín Rodríguez3, Fernando Tornero4, Arturo José Ramos Martín-Vegue5, José Antonio Herrero6, Juan Luis Cruz Bermúdez7. 1. Servicio de Nefrología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España. 2. Servicio de Nefrología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España; RedinRen 0016/009/009 RETYC ISCII. Electronic address: josem.portoles@salud.madrid.org. 3. Servicio de Nefrología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España; RedinRen 0016/009/009 RETYC ISCII. 4. Junta Directiva, Sociedad Madrileña de Nefrología-SOMANE. 5. Servicio de Admisión y Documentación Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España. 6. Comite técnico, Registro Madrileño de Enfermos Renales-REMER. 7. Servicio de Informática, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Politécnica de Madrid, Madrid, España.
Abstract
INTRODUCTION AND OBJECTIVES: Chronic kidney disease has a high prevalence and economic impact, and an increased risk of hospitalization. Although there are public regional and country registries, we have not found references to estimate the impact of renal replacement therapy (RRT) on hospital admissions. METHODS: We obtained authorization from the ethics committee and health authorities to integrate the REMER [Madrid Kidney Disease Registry] (2013-2014) and Minimum Basic Data Set (2013-2015) databases and to analyze the admissions during the first year of RRT. RESULTS: 767 patients started RRT in all the hospitals of our region across all RRT modalities. More than a third of the patients start dialysis during a hospital admission. This unplanned start, more common in HD than PD, shows relevant differences in patient profile or admission characteristics. Without considering this initial episode, almost 60% of patients were admitted during their first year. The hospitalization rate was 1.2admissions/patient, higher in HD than in TX or PD; the mean length of stay was 8.6days. The estimated cost of admissions during the first year is €12,006/patient. Our analysis ensures the exhaustive inclusion of all episodes and accurate estimation based on the discharge form. CONCLUSION: The impact of RRT on hospitals has been underestimated and is very relevant when calculating the total cost of RRT. Results from other countries cannot be extrapolated due to differences in the health system and patient profile. The integration of clinical databases could open up an opportunity that needs only institutional support for its development.
INTRODUCTION AND OBJECTIVES:Chronic kidney disease has a high prevalence and economic impact, and an increased risk of hospitalization. Although there are public regional and country registries, we have not found references to estimate the impact of renal replacement therapy (RRT) on hospital admissions. METHODS: We obtained authorization from the ethics committee and health authorities to integrate the REMER [Madrid Kidney Disease Registry] (2013-2014) and Minimum Basic Data Set (2013-2015) databases and to analyze the admissions during the first year of RRT. RESULTS: 767 patients started RRT in all the hospitals of our region across all RRT modalities. More than a third of the patients start dialysis during a hospital admission. This unplanned start, more common in HD than PD, shows relevant differences in patient profile or admission characteristics. Without considering this initial episode, almost 60% of patients were admitted during their first year. The hospitalization rate was 1.2admissions/patient, higher in HD than in TX or PD; the mean length of stay was 8.6days. The estimated cost of admissions during the first year is €12,006/patient. Our analysis ensures the exhaustive inclusion of all episodes and accurate estimation based on the discharge form. CONCLUSION: The impact of RRT on hospitals has been underestimated and is very relevant when calculating the total cost of RRT. Results from other countries cannot be extrapolated due to differences in the health system and patient profile. The integration of clinical databases could open up an opportunity that needs only institutional support for its development.