Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Clinical Practice: Mini-Review

Free Access

The Economic Consequences of Acute Kidney Injury

Silver S.A.a, b · Chertow G.M.a

Author affiliations

aDivision of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA; bDivision of Nephrology, University of Toronto, Toronto, ON, Canada

Corresponding Author

Dr. Glenn M. Chertow

Division of Nephrology

Stanford University School of Medicine

1070 Arastradero Road, Palo Alto, CA 94304 (USA)

E-Mail gchertow@stanford.edu

Related Articles for ""

Nephron 2017;137:297–301

Do you have an account?

Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



Abstract

Acute kidney injury (AKI) is an increasingly common condition associated with poor health outcomes. Combined with its rising incidence, AKI has emerged as a major public health concern with high human and financial costs. In England, the estimated inpatient costs related to AKI consume 1% of the National Health Service budget. In the United States, AKI is associated with an increase in hospitalization costs that range from $5.4 to $24.0 billion. The most expensive patients are those with AKI of sufficient severity to require dialysis, where cost increases relative to patients without AKI range from $11,016 to $42,077 per hospitalization. Even with these high costs, significant hospital-level variation still exists in the cost of AKI care. In this article, we review the economic consequences of AKI for both the general and critically ill AKI population. Our primary objective is to shed light on an opportunity for hospitals and policymakers to develop new care processes for patients with AKI that have the potential to yield substantial cost savings. By exposing the high rates of death and disability experienced by affected patients and the immense financial burden attributable to AKI, we also hope to motivate scientists and entrepreneurs to pursue a variety of innovative therapeutic strategies to combat AKI in the near term.

© 2017 S. Karger AG, Basel


References

  1. Waikar SS, Liu KD, Chertow GM: Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 2008;3:844-861.
  2. Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS: Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014;9:12-20.
  3. Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, Jaber BL: World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol 2013;8:1482-1493.
  4. Selby NM, Kolhe NV, McIntyre CW, Monaghan J, Lawson N, Elliott D, Packington R, Fluck RJ: Defining the cause of death in hospitalised patients with acute kidney injury. PLoS One 2012;7:e48580.
  5. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P: Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7-20.
  6. Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van Straaten H, Ronco C, Kellum JA: Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med 2007;33:1563-1570.
  7. Coca SG, Singanamala S, Parikh CR: Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012;81:442-448.
  8. Odutayo A, Wong CX, Farkouh M, Altman DG, Hopewell S, Emdin CA, Hunn BH: AKI and long-term risk for cardiovascular events and mortality. J Am Soc Nephrol 2017;28:377-387.
  9. Villeneuve PM, Clark EG, Sikora L, Sood MM, Bagshaw SM: Health-related quality-of-life among survivors of acute kidney injury in the intensive care unit: a systematic review. Intensive Care Med 2016;42:137-146.
  10. Johansen KL, Smith MW, Unruh ML, Siroka AM, O'Connor TZ, Palevsky PM: Predictors of health utility among 60-day survivors of acute kidney injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study. Clin J Am Soc Nephrol 2010;5:1366-1372.
  11. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY: Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol 2013;24:37-42.
  12. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16:3365-3370.
  13. Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, Thottakkara P, Efron PA, Moore FA, Moldawer LL, Segal MS, Bihorac A: Cost and mortality associated with postoperative acute kidney injury. Ann Surg 2015;261:1207-1214.
  14. Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA: Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol Dial Transplant 2008;23:1970-1974.
  15. Ayanian JZ, Weissman JS: Teaching hospitals and quality of care: a review of the literature. Milbank Q 2002;80:569-593, v.
  16. Kerr M, Bedford M, Matthews B, O'Donoghue D: The economic impact of acute kidney injury in England. Nephrol Dial Transplant 2014;29:1362-1368.
  17. Fischer MJ, Brimhall BB, Lezotte DC, Glazner JE, Parikh CR: Uncomplicated acute renal failure and hospital resource utilization: a retrospective multicenter analysis. Am J Kidney Dis 2005;46:1049-1057.
  18. Silver SA, Long J, Zheng Y, Chertow GM: Cost of acute kidney injury in hospitalized patients. J Hosp Med 2017;12:70-76.
  19. Grams ME, Waikar SS, MacMahon B, Whelton S, Ballew SH, Coresh J: Performance and limitations of administrative data in the identification of AKI. Clin J Am Soc Nephrol 2014;9:682-689.
  20. Srisawat N, Lawsin L, Uchino S, Bellomo R, Kellum JA: Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study. Crit Care 2010;14:R46.
  21. Manns B, Doig CJ, Lee H, Dean S, Tonelli M, Johnson D, Donaldson C: Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med 2003;31:449-455.
  22. Hamel MB, Phillips RS, Davis RB, Desbiens N, Connors AF Jr, Teno JM, Wenger N, Lynn J, Wu AW, Fulkerson W, Tsevat J: Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 1997;127:195-202.
  23. Laukkanen A, Emaus L, Pettila V, Kaukonen KM: Five-year cost-utility analysis of acute renal replacement therapy: a societal perspective. Intensive Care Med 2013;39:406-413.
  24. Stewart J, Findlay G, Smith N, Kelly K, Mason M: Adding Insult to Injury: A Review of the Care of Patients Who Died in Hospital with a Primary Diagnosis of Acute Kidney Injury (Acute Renal Failure). A Report by the National Confidential Enquiry into Patient Outcome and Death, 2009. www.ncepod.org.uk/2009aki.htm (accessed April 4, 2016).
  25. Think Kidneys. www.thinkkidneys.org (accessed November 14, 2016).

Article / Publication Details

First-Page Preview
Abstract of Clinical Practice: Mini-Review

Received: March 24, 2017
Accepted: April 10, 2017
Published online: June 09, 2017
Issue release date: Published online first

Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 1

ISSN: 1660-8151 (Print)
eISSN: 2235-3186 (Online)

For additional information: https://www.karger.com/NEF


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.