Adverse safety event characteristics and predictive factors in hospital encounters for patients with chronic kidney disease

Mary Lynn Davis-Ajami, Jeffery C. Fink, Marianne Baernholdt, Jun Wu

Research output: Contribution to journalArticle

Abstract

Background: Adverse safety events (ASE) during hospitalization may contribute to renal decline or poor outcomes. Understanding factors contributing to ASE in chronic kidney disease (CKD) is limited. The objective is to compare differences and determine predictors of renal pertinent ASE in discharges for CKD. Method: A cross-sectional analysis of the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2012 data. The study included adults age ≥18 years with discharge diagnosis for CKD stages 1-4, excluding cancer of the kidney and renal pelvis, renal transplant, end-stage renal disease. Predictors included study sample characteristics, including patient demographics, comorbidity, and hospitalization-related variables. Outcomes assessed included distribution of ASE (angioedema, confusion, muscle weakness or cramps, lower extremity edema (LEE), falls, hypoglycemia, nausea-vomiting-diarrhea (NVD), and skin rash), mean total charge per hospital event, and length-of-stay. The analytical approach used descriptive statistics (means and proportions) and bivariate analysis to compare differences (ASE versus none). Predictors of ASE were explored using multivariate logistic regression. Results: 10.3% of inpatient discharges for CKD showed an ASE. Mean charges (USD 48,072 vs. 46,996), days length-of-stay (6.8 vs. 5.7), number of diagnosis on record (6.8 vs. 5.7), geographical region (Midwest, and West), and type of hospital (rural) were significantly associated with ASE. Most common ASEs were confusion (18%), LEE (21.3%), and NVD (50.7%). Odds of ASE increased for age, female gender, rural hospitals, geographical region, and diagnosis for anemia, coagulopathies, depression, fluid and electrolyte disorders, neurological disorders, psychoses, and weight loss. Conclusions: We identified key factors that increase the risk of ASE in patients with CKD. Opportunities exist to reduce ASE in CKD.

Original languageEnglish (US)
Pages (from-to)72-80
Number of pages9
JournalAmerican journal of nephrology
Volume50
Issue number1
DOIs
StatePublished - Jul 1 2019

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Keywords

  • Adverse safety events
  • Chronic kidney disease

ASJC Scopus subject areas

  • Nephrology

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