Healthcare burden of venous thromboembolism in childhood chronic renal diseases.

BACKGROUND: Chronic renal diseases (CRD) are associated with approximately 5% of pediatric venous thromboembolism (VTE) cases, but the epidemiology of VTE in CRD is ill-defined.

METHODS: Children (<18 years) with CRD were identified from MarketScan® Research databases. The VTE status of subjects with CRD who qualified for this study was ascertained during the 6 months following the initial diagnosis of CRD. Demographics, healthcare utilization, mortality, and co-morbid conditions were assessed.

RESULTS: A total of 22,877 children with predefined CRD ICD-9-CM codes were identified between April 1, 2003 and June 30, 2012, among whom 0.55% had VTE. Our analysis revealed that in-hospital mortality was more likely in children with VTE than in those without VTE (11.9 vs. 0.9%, respectively; p < 0.0001). The usage of healthcare facilities, based on the number of inpatient admissions, length of stay, outpatient visits, and pharmaceutical claims, was also significantly higher in patients with VTE than in those without (p < 0.0001). Total mean healthcare expenditures for the 6-month follow-up period were 13-fold greater in the VTE group than in the group without VTE ($338,338 ± $544,045 vs. $25,171 ± $90,792; p < 0.0001). In a multivariate model, infection, hemodialysis, and trauma/surgery significantly increased the likelihood of VTE.

CONCLUSIONS: Venous thromboembolism is rare in children with CRD, but it is associated with higher mortality and healthcare utilization when present. Among the children with CRD enrolled in our study, the likelihood of VTE was increased among those with co-morbid, non-renal chronic conditions.