Khan Samina, Tighiouart Hocine, Kalra Aarti, Raman Gowri, Rohrer Richard J, Pereira Brian J G
Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
Kidney Int. 2003 Aug;64(2):657-64. doi: 10.1046/j.1523-1755.2003.00102.x.
Hospitalization consumes a significant portion of the end-stage renal disease (ESRD) program, which includes kidney transplant recipients. Identification of kidney transplant recipients at risk of increased resource utilization could lead to appropriate interventions to attenuate the complications related to kidney transplant, which may reduce resource utilization.
This retrospective cohort study of kidney transplant recipients was performed to identify risk factors for hospital utilization. The study population consisted of patients who received kidney transplant at our center between October 1990 and September 1999 and were followed in the outpatient clinic.
Of the 220 patients, 171 (78%) were hospitalized during a median follow-up of 36 months. The number of hospitalizations, hospital days, and outpatient visits per patient-year at risk were 1.1, 6.3, and 21.6, respectively. Infection episodes were the leading cause of hospitalization. In a multivariate regression analysis, cytomegalovirus (CMV)-positive status of donor (RR 1.58; 95% CI 1.15, 2.18) and a higher number of hospital days during the transplant hospitalization (RR 1.10 per 7 days increase; 95% CI 1.03, 1.19) were associated with a higher risk of hospitalization, while higher serum albumin (RR 0.84 per 0.5 g/dL increase; 95% CI 0.73, 0.97), higher hematocrit (RR 0.95 per 1% increase; 95% CI 0.92, 0.98), higher glomerular filtration rate (GFR) (RR 0.91 per 10 mL/min/1.73 m2; 95% CI 0.85, 0.99), and an increased interval since transplant (RR 0.84 per 6 months increase; 95% CI 0.75, 0.93) were associated with a lower risk of hospitalization. CMV-positive status of the donor (RR 1.11; 95% CI 1.00, 1.21) and presence of cardiovascular disease (RR 1.12; 95% CI 1.00, 1.24) were associated with a higher risk of outpatient visits, while Caucasian race (RR 0.82; 95% CI 0.73, 0.94), higher serum albumin (RR 0.88 per 0.5 g/dL increase; 95% CI 0.84, 0.93), higher hematocrit (RR 0.96 per 1% increase; 95% CI 0.95, 0.97), and an increased interval since transplant (RR 0.79 per 6 months increase; 95% CI 0.76, 0.83) were associated with a lower risk of outpatient visits.
Identification of risk factors associated with increase resource utilization among kidney transplant recipients could aid in the development of targeted interventions to improve clinical and economic outcomes.
住院治疗占终末期肾病（ESRD）项目（包括肾移植受者）的很大一部分。识别有资源利用增加风险的肾移植受者，可能会促使采取适当干预措施来减轻与肾移植相关的并发症，这可能会降低资源利用。
本研究对肾移植受者进行回顾性队列研究，以确定住院利用的风险因素。研究人群包括1990年10月至1999年9月在我们中心接受肾移植并在门诊随访的患者。
在220例患者中，171例（78%）在中位随访36个月期间住院。每位有风险患者每年的住院次数、住院天数和门诊就诊次数分别为1.1次、6.3天和21.6次。感染发作是住院的主要原因。在多因素回归分析中，供体巨细胞病毒（CMV）阳性状态（相对危险度1.58；95%置信区间1.15，2.18）和移植住院期间住院天数较多（每增加7天相对危险度1.10；95%置信区间1.03，1.19）与住院风险较高相关，而血清白蛋白较高（每增加0.5 g/dL相对危险度0.84；95%置信区间0.73，0.97）、血细胞比容较高（每增加1%相对危险度0.95；95%置信区间0.92，0.98）、肾小球滤过率（GFR）较高（每增加10 mL/min/1.73 m2相对危险度0.91；95%置信区间0.85，0.99）以及移植后间隔时间增加（每增加6个月相对危险度0.84；95%置信区间0.75，0.93）与住院风险较低相关。供体CMV阳性状态（相对危险度1.11；95%置信区间1.00，1.21）和存在心血管疾病（相对危险度1.12；95%置信区间1.00，1.24）与门诊就诊风险较高相关，而白种人（相对危险度0.82；95%置信区间0.73，0.94）、血清白蛋白较高（每增加0.5 g/dL相对危险度0.88；95%置信区间0.84，0.93）、血细胞比容较高（每增加1%相对危险度0.96；95%置信区间0.95，0.97）以及移植后间隔时间增加（每增加6个月相对危险度0.79；95%置信区间0.76，0.83）与门诊就诊风险较低相关。
识别肾移植受者中与资源利用增加相关的风险因素，有助于制定有针对性的干预措施，以改善临床和经济结局。
