Trends and outcomes of chronic kidney disease in intensive care: a 5-year study.

BACKGROUND: The prevalence of chronic kidney disease (CKD) is increasing in Australia and is independently associated with a higher risk of hospitalisation and death. Australian data may be useful in guiding improved hospital management of this growing cohort of patients.

AIM: To assess and compare the trends and outcomes of CKD patients requiring hospital and intensive care unit (ICU) admission at a tertiary referral hospital and state public hospitals.

METHODS: We conducted a retrospective analysis of all acute care admissions to St Vincent's Hospital Melbourne and all Victorian public hospitals using the Victorian Admitted Episodes Data Set (VAED) for the years 2010-2014 to determine CKD prevalence, demographic and outcome associations. The Elixhauser ICD-10 comorbidity classification of renal failure was used to identify CKD (ElixRF). Chi-squared test, Kruskal-Wallis test and logistic regression were used for analysis.

RESULTS: A total of 101 817 patients was included from our institution, with 6.4% classified as having ElixRF. ELixRF increased from 5.2% in 2010 to 8.6% in 2014 for all hospital admissions and from 8.3% to 13.3% for ICU admissions. ElixRF was associated with longer hospital and ICU length of stay, male gender, older age, higher comorbidity and independently with increased mortality. The VAED contained 2 044 507 episodes for the same period with similar trends and associations.

CONCLUSIONS: CKD prevalence amongst patients admitted to hospital and ICU is increasing and is associated with worse outcomes. ElixRF may be a useful administrative flag for nephrologist involvement in care and for prompting consideration of advanced care planning.