Factors associated with mortality and high treatment expense of adult patients hospitalized with chronic kidney disease in Thailand

Background: Chronic kidney disease (CKD) is a global public health problem with a high risk of hospitalization and death. Few nationwide data have been reported regarding the outcomes of patients hospitalized with CKD in developing countries. Objectives: To study the risk factors associated with mortality and high treatment costs of adult patients hospitalized with CKD in Thailand. Methods: The medical data forms for adult inpatients with CKD collected in fiscal year 2010 were analyzed to determine the number of CKD admissions, associated comorbidities and complications, mortality rates, and hospital charges. Factors influencing mortality rates were evaluated by multiple logistic regression. Results: The total number of CKD patients was 128,338. After adjustment, the major factors associated with high hospital charges were (a) comorbidities (e.g. pneumonia OR 3.18, 95% CI 3.03-3.34; sepsis OR 2.87, 95% CI 2.74-3.00; acute kidney injury (AKI) on preexisting CKD OR 2.83, 95% CI 2.69-2.98) and (b) dialysis treatment (i.e., hemodialysis OR 5.16, 95% CI 4.94-5.39; peritoneal dialysis OR 3.40, 95% CI 3.14-3.69). The risk factors for high mortality were: being male, elderly, having comorbidity (viz., sepsis, respiratory failure, stroke, pneumonia, ischemic heart disease, AKI in addition to CKD, heart failure, and diabetes), and CKD complications (viz., metabolic acidosis, hyperkalemia, volume overload, and anemia requiring blood transfusion). Conclusions: Prevention and early treatment of any comorbidity and complications of CKD might reduce mortality and treatment costs of patients hospitalized with CKD.