Morbidity burden of end‐stage kidney disease in Australia: Hospital separation rates among people receiving kidney replacement therapy

Abstract

Mortality associated with dialysis and transplantation is well characterized. Less well described are hospital separation rates for "non-renal" diagnoses among people receiving kidney replacement therapy (KRT = haemodialysis, peritoneal dialysis and kidney transplantation). We examined these rates among Australians receiving KRT. Observational study based on Australian National Hospital Morbidity Database, incorporating Australian public and private hospitals. Separations from this dataset were examined for 2002-7, excluding day-only haemodialysis. ICD (International Classification of Disease) codes were used to identify separations for people receiving chronic KRT. Separations categorized into "renal" and "non-renal" by principal diagnosis. Separation rate, admission length and in-hospital mortality were compared with the general population. Overall hospital separation rate (adjusted for age and gender) was increased relative to the general population for all groups: for HD patients, relative rate (RR) was 4.49 [95% confidence interval 4.460-4.53]; for PD patients 5.52 [5.460-5.59]; for transplant recipients 4.83 [4.20-4.28] (all p < 0.001). When restricted to separations with a "non-renal" principal diagnosis, the excess remained among KRT groups: HD adjusted RR 2.20 [2.170-2.22], PD 2.00 [1.950-2.04] and transplants 2.63 [2.600-2.66], all p < 0.001). The length and in-hospital mortality for separations in each KRT group was also increased. By ICD-10 chapter, rates of separations with infectious and metabolic causes were increased in all KRT groups; separations with circulatory and respiratory causes were also increased. Among people receiving KRT in Australia, there is a substantial burden of morbidity in addition to that directly related to KRT. This is most marked for infective, endocrine and circulatory and respiratory hospitalisations.