Comorbid CKD is a “significant risk factor” for potentially preventable complications among people hospitalized for any reason, according to an analysis of almost 250,000 patient records.
“This analysis demonstrates for the first time that after being admitted to a hospital, these [CKD] patients are more likely to have adverse events related to potential lapses in patient safety,” University of Maryland researchers wrote in the Journal of the American Society of Nephrology (2008; published online ahead of print).
Using data from Veterans Administration hospitals, the researchers tallied 18 patient safety indicators (PSIs), as defined by the federal Agency for Healthcare Research and Quality (AHRQ). These events were 19% more likely to occur among the 71,700 patients with CKD. Their vulnerability rose with the severity of their disease. Patients with a pre-admission glomerular filtration rate (GFR) below 30 mL/min/1.73 m2 faced a 59% greater risk; those whose GFR was 30-45 had a 20% increased risk.
After adjusting for race, age, gender, and the presence of cardiovascular disease or diabetes, CKD patients were at increased risk of the following:
- Postoperative physiologic or metabolic derangement (four times higher);
- Infection as a result of medical care (2.3 times higher);
- Complications of anesthesia (60% higher)
- Death associated with low-mortality conditions (53% higher);
- Postoperative sepsis (39% higher);
- Postoperative respiratory failure (37% higher);
- Physiologic derangement in medical and surgical admissions combined (36% higher);
- Postoperative MI in the hospital (18% higher);
- Postoperative hip fracture (4.9 times higher).
Led by Jeffrey Fink, MD, MS, the team lists several explanations of their findings. For example, CKD patients are hospitalized more often than the general population and their impaired renal clearance inherently “raises the risk for incorrect dosing and toxicity of therapeutic agents.”
But, “most important,” they write, “CKD is frequently unrecognized in most health-care settings, leaving providers unprepared to address the preventable consequences of this disease and its complexities.”