婴儿ESKD的复杂性和保健利用。

IF 3 Q1 UROLOGY & NEPHROLOGY
Kidney360 Pub Date : 2025-09-09 DOI:10.34067/KID.0000000959
Ashna R Pudupakkam, Michael C Braun, Catherine Joseph, Poyyapakkam R Srivaths, Sarah J Swartz, Shweta S Shah
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引用次数: 0

摘要

背景:ESKD新生儿的透析通常与多种合并症相关,需要更强化的透析方案。随着产前干预和婴儿特异性KRT的最新进展,ESKD新生儿的生存率在过去十年中有所改善。然而,对于改善这一人群的生存对医疗保健系统的影响知之甚少。我们的主要目的是调查ESKD婴儿的医疗保健利用情况。方法:我们对2011年至2022年在德克萨斯儿童医院(TCH)首次入院时接受KRT治疗的ESKD婴儿进行了回顾性研究。主要纳入标准是在TCH新生儿重症监护病房(NICU)开始慢性透析的患者和存活至出院的患者。提取的数据包括患者人口统计、住院次数和住院时间(LOS)、合并症、儿科专科护理、与首次住院、透析护理和出院后护理相关的医院总收费,直至2岁。结果:19例患者在新生儿重症监护室开始透析,出院时进行慢性透析:68%为男性,79%胎龄≥37周,90%出生体重≥2500 g。初次住院的平均住院时间为200天(标准差为48天),平均8次专科会诊。2岁前平均入院5次,平均门诊次数15次。初次住院的护理费用中位数为120万美元,透析费用占总费用的16%。出院后至2岁的护理总费用中位数为467,607美元。结论:婴儿ESKD与显著的医疗保健利用相关,包括住院、持续的非肾病亚专科护理和显著的财务支出。对该患者群体医疗保健利用情况的进一步调查可以帮助指导资源的适当分配,以支持医疗服务的提供。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Complexity and Health Care Utilization in Infant ESKD.

Background: Dialysis in neonates with ESKD is often associated with multiple comorbidities and the need for more intensified dialysis regimens. With recent advances in prenatal interventions and infant specific KRT, survival of neonates with ESKD has improved over the last decade. Little is known however about the impact on the health care system of improved survival in this population. Our primary aim was to investigate healthcare utilization in infants with ESKD.

Methods: We conducted a retrospective review of infants with ESKD started on KRT during their initial neonatal admission at Texas Children's Hospital (TCH) from 2011 to 2022. The primary inclusion criteria were patients who initiated chronic dialysis in the Neonatal Intensive Care Unit (NICU) at TCH and survival to discharge. Data abstracted included patient demographics, number of hospitalizations and length of stays (LOS), comorbidities, pediatric sub-specialist care, and gross hospital charges related to the initial hospitalization, dialytic care, and care post-discharge up to the age of 2 years.

Results: 19 patients initiated dialysis in the NICU and were discharged on chronic dialysis: 68% were male, 79% had a gestational age ≥ 37 weeks, and 90% had a birth weight ≥2500 g. The average LOS for the initial hospitalization was 200 days (standard deviation of 48 days) with an average of 8 subspecialty consults. There were on average 5 admissions prior to age 2 years and 15 average outpatient visits per patient. The median cost of care for the initial hospitalization was $1.2 million with dialysis accounting for 16% of the total cost. The median aggregate cost of care post-discharge until age 2 years was $467,607.

Conclusions: Infant ESKD is associated with significant healthcare utilization including hospitalizations, on-going non-nephrology sub-specialty care, and significant financial expenditures. Further investigation of healthcare utilization in this patient population can help guide the appropriate allocation of resources to support care delivery.

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Kidney360
Kidney360 UROLOGY & NEPHROLOGY-
CiteScore
3.90
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