Taliwal Neal, Pandya Aadi, Dixon Angelina, Tibrewal Abhishek, Kumar Rohan J, Doshi Kush, Warady Bradley A, Raina Rupesh
Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Pediatr Nephrol. 2025 Apr;40(4):1059-1068. doi: 10.1007/s00467-024-06568-2. Epub 2024 Nov 7.
Children with chronic kidney disease (CKD) face extensive healthcare needs, leading to substantial financial strain on both families and healthcare systems due to costly kidney replacement therapies and associated comorbidities. Limited research on inpatient healthcare utilization is available for the individual stages of pediatric CKD.
This retrospective cohort study included inpatient encounters for pediatric patients (≤ 18 years) using the Pediatric Health Information System Database (PHIS) between January 2016 and December 2022, with an ICD-10 code for any CKD stage (1-5). Hospitalization cost, length of stay (LOS), morbidity, and mortality data were collected.
We identified 23,980 pediatric CKD cases [stage 1: 5,059, stage 2: 6,763, stage 3: 7,012, stage 4: 3,102, and stage 5: 2,044] across 49 different children's hospitals in the United States. Mortality rates were observed to increase with increasing CKD severity, but no clear trend was observed for surgical, medical, and infection rates by CKD stage. The LOS for patients with CKD stage 4 and CKD stage 5 was 56% and 71% longer relative to the LOS of a typical hospitalization for a patient without CKD, and the billed charges for these hospitalizations were 92% and 147% higher than those of a typical hospitalization.
LOS and hospitalization costs were significantly higher for patients with CKD than for patients without CKD. Furthermore, pediatric patients with stage 5 CKD had significantly higher in-patient costs and all-cause hospitalization LOS compared to those with CKD stages 1-4.
慢性肾脏病（CKD）患儿面临广泛的医疗需求，由于昂贵的肾脏替代治疗及相关合并症，给家庭和医疗系统带来了巨大的经济压力。关于儿科CKD各个阶段住院医疗利用情况的研究有限。
这项回顾性队列研究纳入了2016年1月至2022年12月期间使用儿科健康信息系统数据库（PHIS）的儿科患者（≤18岁）的住院病例，这些病例具有任何CKD阶段（1 - 5期）的国际疾病分类第十版（ICD - 10）编码。收集了住院费用、住院时长（LOS）、发病率和死亡率数据。
我们在美国49家不同的儿童医院中识别出23980例儿科CKD病例[1期：5059例，2期：6763例，3期：7012例，4期：3102例，5期：2044例]。观察到死亡率随CKD严重程度增加而上升，但未观察到CKD各阶段手术、医疗和感染率的明显趋势。CKD 4期和5期患者的住院时长相对于无CKD患者的典型住院时长分别长56%和71%，这些住院的计费费用比典型住院费用分别高92%和147%。
CKD患者的住院时长和住院费用显著高于无CKD患者。此外，与CKD 1 - 4期患者相比，5期CKD儿科患者的住院费用和全因住院时长显著更高。
