Kidney transplantation in the United States: Economic burden and recent trends analysis

Cleveland Clinic Children's Hospital, Cleveland, Ohio.
Progress in transplantation (Aliso Viejo, Calif.) (Impact Factor: 0.84). 03/2013; 23(1):78-83. DOI: 10.7182/pit2013149
Source: PubMed


As kidney transplant is the preferred mode of management of advanced kidney disease and economic trends for kidney transplant procedures are not well known, data were analyzed to assess these trends.

Data source:
Annual data for 1998 to 2008 from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality were used to analyze characteristics of patients discharged from hospitals in the United States with kidney transplant as the primary procedure. DATA SYNTHESIS/RESULTS: The population more than 65 years old had the most significant increase in hospitalizations for kidney transplant procedures (P< .01). The mean length of stay decreased by 2.8 days over the period studied (P= .02). Mean hospital charge increased despite a decrease in length of stay resulting in a 225% increase in charge per day of hospitalization, from $6907 in 1998 to $22 484 in 2008. The national aggregate hospital charges for kidney transplant procedures rose from $0.9 billion in 1998 to $3.1 billion in 2008. Kidney transplant was overall ranked sixth by mean cost per hospitalization and ranked seventh by mean charge per hospitalization among the Clinical Classification Software's Services and Procedures in this database in 2008.

Despite shorter hospital stays, the economic burden of kidney transplants increased from 1998 to 2008.

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    ABSTRACT: Abstract Objective: To measure the incidence and outcomes of pregnancies in renal transplant (RT) patients and to identify risk factors of adverse pregnancy outcomes. Methods: We conducted a population-based retrospective cohort study using the United States Nationwide Inpatient Sample from 2003-2010. The incidence of pregnancies in women with RT was measured and logistic regression analysis was used to estimate the adjusted effect of RT on maternal and fetal outcomes. Results: We identified 375 deliveries in patients with a RT among 7,094,300 births for an overall incidence of 5.3 cases per 100,000 births over 8 years. Maternal complications, including preeclampsia OR=9.87 (7.76, 12.55) and blood transfusion OR= 2.29 (1.69, 3.12) were more common in women with RT as compared to in women without. RT pregnancies were also complicated by an increased risk of preterm birth OR=4.65 (3.72, 5.81), intrauterine fetal death OR=3.67 (1.89, 7.15) and fetal congenital anomalies OR= 5.28 (2.81, 9.90). Among women with RT and pre-existing hypertension, the risk of IUGR was considerably increased from 4.3% to 21.8%, OR= 3.79 (1.67, 8.62). Conclusion: Pregnancies in RT patients are associated with an increased risk of maternal and fetal morbidities. Among women with RT, pre-existing hypertension strongly increases the risk of IUGR.
    No preview · Article · Mar 2014 · The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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    ABSTRACT: Objectives Obesity is often associated with higher hospital costs because of longer length of stay (LOS) but this has not been well studied in the kidney transplant population. Therefore, we used national data to compare LOS in select groups of morbidly obese and normal weight recipients after kidney transplant. Design This study was a retrospective analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database. Subjects The study sample consisted of 42,787 morbidly obese (body mass index 35-40 kg/m2) and normal weight (body mass index 18.5-24.9 kg/m2) who underwent primary kidney-only transplantation between 2000 and 2008. Main Outcome Measures Morbidly obese and normal-weight subgroups were crudely evaluated for prolonged LOS (>7 days). Logistic regression modeling compared LOS in morbidly obese and normal-weight subgroups with varying characteristics and determined predictors of prolonged LOS. Results All morbidly obese subgroups had significantly higher crude rates of prolonged LOS (P < .05). However, no significant differences in prolonged LOS were seen between any of the morbidly obese or normal-weight subgroups in multivariate analysis. Morbid obesity was an independent predictor of prolonged LOS (P < .001) but not a stronger predictor than that of being African American, having coronary artery disease, diabetes mellitus, or peripheral vascular disease, being 50 to 80 years of age, having a previous transplant or poor functional status. Receiving a deceased-donor transplant and being dialysis dependent >4 years were significantly better predictors of prolonged LOS compared with morbid obesity (P < .05). Conclusions Some morbidly obese populations have LOS rates that are not significantly different than many commonly transplanted normal weight populations, and the impact morbid obesity has on LOS is not different than many other factors often seen in kidney transplant recipients; therefore, morbid obesity alone should not be a financial consideration in kidney transplant.
    Full-text · Article · Nov 2014 · Journal of Renal Nutrition